A federal watchdog agency sent a warning shot to the hospice industry and called on the Centers for Medicare & Medicaid Services to help providers fix documentation gaps that fail to show Medicare patients receiving end-of-life services are terminally ill.
In order for Medicare to pay for hospice services, patients must sign a form electing to receive hospice care and a physician must certify that the patient is terminally ill. But a new report released by the Office of Inspector General found that in more than one-third of general inpatient stays, hospital election statements lacked essential information. In 19 percent of cases the elected statement did not indicate the hospice services were provided through Medicare, and in 12 percent of cases the statement did not specify that the patient was waiving Medicare coverage for other services.
Further, a physician did not adequately certify that the patient was terminally ill in 14 percent of claims. In 10 percent of claims physicians only included the patient’s diagnosis, failing to provide additional information about why the patient was considered terminally ill.
The OIG noted it has “investigated numerous cases in which hospices submitted fraudulent claims for patients who were not appropriate for hospice care.” In April, the agency said that Medicare spent $268 million on inappropriate hospice claims, many of which involved beneficiaries that did not require hospice services. The report added to previous evidence that hospice overpayments were problematic in general inpatient stays.
The OIG recommended CMS give hospice providers samples for election statements and train surveyors to review both election statements and physician certifications. After repeated calls for hospice payment reform, last year CMS said it would revisit the benefit structure.