Medicare spent $268M on inappropriate hospice claims

Medicare spent $268 million on inappropriate claims for inpatient hospice services designed to manage symptoms and pain over a short period of time, according to a new report from the Office of Inspector General.

Nearly one-third of 2012 hospice claims for general inpatient care (GIP)--the second most expensive level of hospice care designed for short-term stays for patients with less than six months to live--were inappropriate because the beneficiary did not need GIP services during all or part of their stay. In a small portion of cases, there was no evidence that the beneficiary wanted hospice services or had a terminal illness.

In one instance, a hospice provider billed for GIP services for a patient with a circulatory disease that could have been cared for at home. Instead, the provider collected more than $31,000 in reimbursement for 46 consecutive days of GIP. The OIG singled out Florida for its high percentage of inappropriate GIP stays. It also said for-profit hospice providers were twice as likely to submit inappropriate claims.

"One hospice billed for general inpatient care for a patient whose symptoms were managed with oral medication," Nancy Harrison, deputy regional inspector general said in an accompanying podcast. "The physician even noted that the patient should return to routine home care, but the hospice billed for inpatient care for two weeks longer than needed."

The OIG outlined six recommendations for the Centers for Medicare & Medicaid Services, including increased oversight of GIP claims, prepayment reviews for lengthy GIP stays, increased surveyor efforts and additional enforcement for hospices that provide poor quality care.

Meanwhile, in Dallas, a hospice executive is suspected of directing nurses to overdose patients on painkillers such as morphine to hasten their deaths and maximize profits, according to NBCDFW. An FBI affidavit says Brad Harris allegedly told nurses to give patients four times the allowable does of medications and texted messages like, "You need to make this patient go bye-bye."

Federal investigators have closely monitored the hospice industry for several years. Spending on hospice services has increased five-fold since 2000, reaching $15 billion in 2012 thanks to an undercurrent of fraud.

To learn more:
- here's the OIG report
- listen to the OIG podcast
- read the NBCDFW article

Related Articles:
Undercurrent of fraud drives rising hospice payments
A glaring hospice fraud worth studying
Hospice fraud cases catching eye of federal investigators

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