Medicare Compliance & Reimbursement

Medicare coverage requirements not met in most cases of benes sent to nursing homes. The 2013 Work Plan reflects the concerns of the HHS Office of Inspector General with regard to the kind of relationships that hospices have with nursing homes and the probability of violation of the Stark laws. The OIG announced only two Medicare hospice topics for review for next year -- "Marketing Practices and Financial Relationships with Nursing Facilities" and "General Inpatient Care." Both are reviews carried over from the current year. "In a recent report, OIG found that 82 percent of hospice claims for beneficiaries in nursing facilities did not meet Medicare coverage requirements," the agency notes. Potential problems may include inappropriate enrollment and compensation to the nursing home, as well as aggressive marketing toward residents. "We will focus our review on hospices that have a high percentage of their beneficiaries in nursing facilities," the OIG notes. [...]