After completing a review of the Medicare hospice program, the Office of Inspector General (OIG) for the U.S. Department of Health & Human Services discovered several key areas where more should be done to protect Medicare beneficiaries and the integrity of the hospice program.
The OIG released a report titled “Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity”, which recommends 15 specific actions recommended to the Centers for Medicare & Medicaid Services (CMS) based on audits, evaluations and investigations. CMS concurred with six of the 15 recommendations as follows:
- Develop additional claims-based information and include it on Hospice Compare along with deficiency data from surveys, including information about complaints filed and resulting deficiencies.
- Work with partners, such as hospitals and caregiver groups, to make available consumer-friendly information explaining the hospice benefit to beneficiaries and their families and caregivers.
- Analyze claims data to identify hospices that engage in practices or have characteristics that raise concerns.
- Take appropriate action to follow up with hospices that engage in practices or have characteristics that raise concerns.
- Increase oversight of general inpatient care claims and focus particularly on general inpatient care provided in skilled nursing facilities given the higher rate at which these stays were inappropriate.
- Implement a comprehensive prepayment review strategy to address lengthy general inpatient care stays so beneficiaries do not have to endure unnecessarily long periods of time in which their pain and symptoms are not controlled.
The OIG is committed to the recommendations included in the report and will continue to work with CMS to promote their implementation.
Click here to read the full report.