“Yes, we need to take a closer look.” A recent HHS Office of Inspector General data brief looked into potential inappropriate payments to nonhospice providers for services to Medicare beneficiaries during the hospice period of care. According to the report, the OIG found $6.6 billion in such payments that government reviewers believed was also covered by hospice and that Medicare was paying twice for the same services. Due to potential for duplicative payments, the OIG concluded there is a need for increased oversight.
The reported listed four takeaways:
- The majority of $6.6 billion payments to nonhospice providers for hospice beneficiaries were for Medicare Part B items and services. Nonhospice payments are payments for items and services provided to beneficiaries outside the Medicare benefit during a hospice period of care.
- Nonhospice payments for Medicare Part A services decreased 45% and for Part B items and services increased 38%.
- Almost half of the 1.2 to 1.6 million hospice beneficiaries each year received nonhospice items and services during a hospice period of care.
- The number of for-profit hospices relative to nonprofit hospices has grown significantly, and the majority of nonhospice payments were associate with for-profit hospices. A prior OIG report identified areas of concern with for-profit hospices.
To be eligible for hospice care, the Medicare beneficiary must be certified as having a terminal illness with a life expectancy of 6 months or less. Upon electing hospice care, the hospice assumes responsibility for medical related to the terminal illness. Essentially, the patient has waived all rights to Medicare coverage for services related to treatment of the terminal illness and related conditions but retains coverage services to treat conditions unrelated to the terminal illness.
The report found most of the nonhospice payments were for Part B services, including physician, SNF, home health, and DME. The Medicare hospice benefit covers nursing care, physical or occupational therapy or speech-language pathology services, medical social services, home health aide and homemaker services, physician’s services medical equipment and supplies, drugs and biologicals, and counseling.
Of course, the potential for duplicative payments – and the need for increased oversight – raises the specter of government investigations and allegations of fraud and abuse against physicians, SNFs, HHAs, and DMEs that have provided services to hospice patients. Such claims not only may require that the provider or practitioner refund the wrongfully billed payments but exposes them to criminal, civil, and administrative enforcement actions and the possibility of devastating sanctions.
Our firm and its attorneys are available to help you navigate the maze and find a way out.
Kennedy Attorneys & Counselors at Law is a health law firm that helps keep its client out of trouble with the government. Federal and State regulatory oversight, compliance and fraud and abuse enforcement can have devastating consequences on providers and practitioners. Our attorneys are experienced in navigating these complexities, and we assist other law firms do the same for their clients. We are available throughout Texas and nationwide. Visit our website at https://www.markkennedylaw.com/ for more information or email Mark Kennedy, the firm’s principal and founder, directly at [email protected] to talk further about your unique situation.