on Hospice Providers
Department of Health & Human
Services (HHS) and the Department of
Justice (DOJ), between 2005 and 2011,
Medicare spending on hospice care for
nursing home residents increased by
70 percent.
come under scrutiny, particularly since
the formation of the Health Care Fraud
Prevention and Enforcement Action
Team (HEAT) in May 2009 by HHS
and the DOJ. During 2012 alone, the
federal government won or negotiated
over $3 billion in health care fraud
judgments and settlements.
issued by the HHS Office of Inspector
General (OIG) that provide a window into
where enforcement will be focused, as
well as recent investigations, cases and
settlements in the hospice world.
focusing on hospice general inpatient
care (GIP), under which short-term pain
control or symptom management that
cannot be managed in other settings
is provided in an inpatient facility (a
Medicare-certified hospice inpatient
unit, a hospital or a Skilled Nursing
Facility (SNF)).
(CMS) staff expressed concerns about
possible misuse of GIP, such as care
being billed for but not provided,
long lengths of stay, and beneficiaries
receiving care unnecessarily." Medicare
paid $1.1 billion for GIP in 2011, mostly
for care provided in hospice inpatient
units. Twenty-three percent of hospice
beneficiaries in 2011 received GIP, with
one-third of the stays exceeding five
days. Conversely, 27 percent of Medicare
hospices did not provide any GIP, and
some of these hospices did not provide
any level of hospice care other than
routine home care.
that it is committed to further review
of long lengths of stay and the use of
GIP in inpatient units, and will conduct
a medical record review to assess
the appropriateness of GIP provided
in different settings. The OIG also
suggested that CMS focus on hospices
that do not provide GIP to ensure those
hospices are offering the necessary levels
of care to beneficiaries. Moreover, the
report cited that in December 2011 the
DOJ reached a $2.7 million settlement in
a qui tam action filed against Arkansas
Hospice, Inc., for allegedly billing
Medicare for GIP when beneficiaries
actually received routine home care,
which has a lower reimbursement rate.
This settlement is a clear indication
that the DOJ and OIG are serious about
auditing GIP claims and joining suits to
recover alleged false claims.
2013. He brings his background as a former general counsel and
compliance officer to focus on transactional, corporate and healthcare
regulatory matters at the firm.
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