Eli's Hospice Insider

The HHS Office of Inspector General continues to train a close eye on Medicaid hospice services, as shown in two new reports.

Report #1: A whopping 92 percent of the 120 Illinois Medicaid hospice claims the OIG reviewed involved direct care furnished by unqualified hospice workers, the OIG says in a new report. For every single one of those claims, hospices failed to show that they and their workers met initial health evaluation requirements of the state. “State regulations specify that an initial health evaluation be completed within 30 days of hire and include a health inventory, physical examination, and tuberculin skin test,” the OIG notes.

Other problems included no background checks documented (20 claims), unmet training requirements such as in-services and orientation (17 claims), and information missing from personnel files (12 claims).

Because the claims sought reimbursement mostly for unaffected room and board payments, Illinois Medicaid overpaid hospices only $13.4 million for 110 deficient claims, the OIG concludes in the report at http://go.usa.gov/8H7j.

Report #2: In Ohio, 16 of the 100 Medicaid hospice claims the OIG reviewed were not proper, the watchdog agency says in a new report. Hospices failed to claim the correct room and board rate in 9 claims and did not properly apply the patient liability portion to the claimed room and board amount for 7 claims.

Also, the OIG found an even bigger problem with election statements in the sampled claims. “A dually eligible beneficiary must elect both Medicare and Medicaid hospice benefits,” the OIG explains. But for 46 of the claims, hospices failed to maintain a Medicaid election form on file. And for 14 of the claims, election statements didn’t contain required language. But because the room and board payments claimed are not considered hospice benefits, there was no reimbursement impact for the election statement shortcomings, the OIG says in the report at http://go.usa.gov/8dqm.