Planning Medical expenses

The Office of Inspector General is calling on the Centers for Medicare & Medicaid Services to improve oversight of some hospices and ensure all hospices provide more transparency to families and improve billing practices. 

In a list of priorities released Tuesday, OIG noted that years of audits, evaluations and investigations into hospice have found problems with some hospice programs, even though many provide great comfort to terminally ill patients and their families. 

“Our reports and investigations have revealed several concerning issues, including poor — sometimes harmful — quality of care, fraud schemes that involve enrolling beneficiaries without their consent, inappropriate billing practices, limited transparency for patients and their families, a payment system that creates incentives to minimize services, and a rapid growth in the number of new hospices, often to take advantage of these conditions,” OIG stated in the report.  

To improve patient care quality and prevent harm, OIG recommended increasing oversight of hospices with a history of serious deficiencies. It also recommended strengthening requirements to report neglect or abuse and making it easier for patients and families to file complaints. 

Among other recommendations, the report urged CMS to improve transparency to patients and families by improving the CMS Hospice Compare website. It recommended including information about complaints filed against agencies, as well as survey reports from state agencies and accrediting organizations. 

In other areas, OIG was critical of the way hospices are paid and how they bill Medicare. The report pointed out that hospices are paid every day, regardless of the amount and quality of care they provide. It advised CMS to tie payments to patient needs and quality of care, “seeking statutory authority if necessary.” 

Hospice programs have come under increased scrutiny due partly to an explosion of new agencies across the U.S. The Hospice Act of 2020 called on CMS to ensure hospice surveyors are better trained and conduct more frequent surveys of programs found to be noncompliant. In January, CMS released new guidance for hospice surveyors. 

Last month, the National Association for Home Care & Hospice, LeadingAge, the National Hospice and Palliative Care Organization and the National Partnership for Healthcare and Hospice Innovation jointly called on CMS to provide better oversight of the hospice program.