Making good on its assurances of enhanced hospice oversight, the Centers for Medicare & Medicaid Services disclosed in a blog post on Tuesday that nearly 400 hospices are under consideration for potential enforcement action.
In July, CMS instituted enhanced oversight rules for new hospices in Arizona, California, Nevada and Texas due to an uptick of fraudulent activity among hospices in those states. CMS simultaneously revealed that it was undergoing a nationwide project to conduct unannounced site visits to every hospice enrolled in Medicare. As of Tuesday, more than 7,000 hospices were visited.
Almost 400 of those 7,000 “are being considered for potential administrative action,” said CMS in the blog post. Some of the selected hospices will only need to submit a valid address to achieve compliance. Others may have to take actions to address the CMS’ finding, otherwise risk deactivation or revocation of their Medicare enrollment.
“Our goal was to protect patients and their families from engaging with fraudulent actors by making sure that each hospice is operational at the address listed on their enrollment form,” noted CMS in the post. “If a hospice was not operational at the address listed on their Medicare enrollment form, CMS exercised its authority to either deactivate or revoke the hospice’s Medicare billing privileges.”
Other action to combat hospice fraud is on the horizon. A pilot program, which will not be bound to the four states under enhanced oversight, will shadow a patient during their first 90 days in hospice care. CMS plans to use this information to verify that Medicare billing is being submitted for eligible patients.
“Hospice has come under increasing fire over recent years, initially from reports about hospices that perform poorly on health and safety standards and endanger vulnerable patients, and more recently with respect to dramatic growth in the number of hospice providers in some western states that have raised program integrity concerns,” said William Dombi, president of the National Association for Home Care & Hospice, in a statement sent to McKnight’s Home Care Daily Pulse. “All concerned have a part to play in addressing these concerns.”
CMS’ proposed Special Focus Program aimed at identifying poor-performing hospices has recently come under scrutiny by industry leaders. In a recent letter, national hospice organizations criticized the program’s selection criteria, alleging that it may unfairly target certain providers.
Editor’s note: This story was updated with a quote from NAHC President William Dombi.
