Medicare Compliance & Reimbursement

Hospices do important work, which is why they aren't exempt from scrutiny, the OIG's latest hit list suggests.

In addition to being labeled a high-fraud area, in the HHS Office of Inspector General's recent report on "Top Management and Performance Challenges," the OIG gives hospice payment as an example of "paymentpolicies [that] create financial incentives that may drive up Medicare costs without improving care for beneficiaries."

Specifically, the report says that "Medicare payments for hospice care to beneficiaries in assisted living facilities have risen much more quickly than payments for hospice care in other settings and that hospices havefinancial incentives to target beneficiaries in assisted living facilities. In 2012, Medicare paid hospices about $1,100 per week per beneficiary receiving care in assisted living facilities, yet hospices typically provided fewer than 5 hours of visits per week per beneficiary."

Among the OIG's list of the hospice industry's sins are "inadequate oversight of certification surveys and staff licensure requirements, care planning failures, inadequate medical and nursing care, and fraudulent enrollments undertaken without beneficiary consent and enrollment of beneficiaries who were not terminally ill." The OIG also chides "some hospices" for billing "for inappropriate general inpatient care (the second highest and most expensive level of hospice care) ... billing for care that was not provided" and "beneficiaries receiving care they did not need."

And the OIG takes hospices to task for lacking required information in care plans. The OIG also "identified numerous instances of quality-of-care problems in the hospice general inpatient care setting."

The OIG does pat HHS on the back for launching Hospice Compare in August and for continuing "to undertake enforcement actions against hospice providers that fraudulently enroll Medicare beneficiaries," according to the report.

The OIG urges CMS to "reform the payment policy for hospices to align payments to costs and address the financial incentives for hospices to target beneficiaries likely to have long stays."

In addition, the OIG encourages CMS to improve hospice oversight by "(1) increasing physician involvement in decisions regarding general inpatient care, (2) establishing additional remedies for poor performing hospices, (3) educating providers and beneficiaries about hospice enrollment requirements, and (4) developing and disseminating model text for hospice election statements."

Plus: "HHS should also continue developing policies that effectively link payment to quality," the OIG continues. "In addition, CMS should monitor hospice providers and claims and refer suspected fraud to OIG, as appropriate."

See the report at oig.hhs.gov/reportsand-publications/top-challenges/2017/2017-tmc.pdf.