If you run a hospice business, then there’s a good chance that Medicare covers a substantial portion of services rendered. This gives your business the flexibility and freedom to care for those who are truly in need, thus furthering your mission. But significant reliance on Medicare can also put your business in jeopardy when those payments are suspended. In fact, the cessation of these payments can be such a blow that it completely undermines your business, making it difficult, if not downright impossible, to stay afloat.
In other words, there’s a lot at stake when Medicare payments are stopped. In this post, we’ll explore some reasons why the government might try to stop Medicare payments to your business and what you can do to hopefully remedy the situation and restart the funding source that you heavily rely upon.^p
When are Medicare payments stopped?
The Centers for Medicare and Medicaid Services have several integrity measures they use to try to weed out fraud and abuse in the government subsidization of healthcare, including hospice care. There are multiple reasons why Medicare payment may be stopped. These include:
- That the Centers for Medicare and Medicaid Services have reason to believe that there’s been overpayment.
- That there’s reason to believe that incorrect payments have been made.
- There’s a credible allegation that a provider has engaged in fraud.
Unfortunately, some of the standards that are applicable here are broad. For example, a “credible allegation of fraud” can come from complaints called into the fraud hotline or provider audits. Of course, payments will likely be suspended if there’s concern regarding kickbacks, forged signatures or self-referral.
What can you do if Medicare payments to your hospice business are stopped?
Although it can be frightening to learn that Medicaid payments to your business have been stopped, you might have options for restarting them. These include:
- Seeking a good cause finding: The government can continue payments, even if there’s a credible allegation of fraud or an overpayment, if it finds good cause to do so. This good cause can include that cessation of payments would jeopardize patient access to needed and beneficial services, which arguably would include hospice care.
- Submitting a rebuttal letter: Although there’s no administrative appeal process to try to reverse the cessation of Medicare payments, you do have the ability to send a rebuttal letter asking the government to change course and reverse its decision.
- Cooperating with the investigation: In most instances, the government isn’t going to restart payments until their fraud investigation is complete and overpayments are corrected. Fighting the government, then, could prolong the process, resulting in more financial damage to your business. It’s best to speak to your attorney about the best way to approach any audit or investigation, though, to ensure that you’re protecting your interests as fully as possible in light of the allegations and facts at hand. You certainly don’t want to make the mistake of implicating your business or yourself in what could turn into a criminal investigation.
Get a handle on Medicare-related payment issues
The best way to get around Medicare payment suspension is to avoid it in the first place. You might be able to do so by implementing standardized billing practices and procedures and regularly conducting internal audits. But even if those efforts fall short, you can still implement legal strategies to protect yourself as fully as possible. Just don’t make the mistake of minimizing the impact of the action taken against you and the stakes involved. That’s why it’s a good idea to include your attorney from the very beginning so that they can help guide you along the way.