A federal report conducted by the Office of the Inspector General (OIG) on Tuesday revealed how some hospices take advantage of Medicare payments and in some cases, are negligent of patients.
Hospice services can play an essential role in ensuring the comfort of terminally ill patients. It is a popular Medicare benefit and certainly an expensive one as hospices are paid uniquely on a per patient, per day basis. According to NPR, Medicare poured $16.7 billion into hospice services in 2016, more than double that of 2006’s payments.
Nancy Harrison, deputy regional inspector general in the U.S. Department of Health and Human Services (HHS) and team leader for the OIG’s study said, “the current payment system creates incentives for hospices to minimize their services and seek beneficiaries who have uncomplicated needs.” Essentially the model creates a loophole for hospice providers to do much less for the same check from Medicare.
“Within each level of care, a hospice is paid for every day a beneficiary is in its care, regardless of the quantity or quality of services provided on that day,” she said.
Naturally, the report shifted eyes to the Centers for Medicare and Medicaid Services (CMS). The agency plays a key role in the funding of hospices and is urged to closely examine the services provided by hospice care to avoid overpayments.
The report found that hospices frequently bill Medicare for high-level care and services that the beneficiary either did not need or receive. The embellishments cost Medicare $268 million in 2012 alone as one-third of general inpatients stays–an expensive level of care–were wrongly billed.
The discrepancies are noticeable; hospices billing routine care as general inpatient stays were paid $672 per day versus the $151 they qualified for.
Medicare also paid twice for the same service in cases where Medicare would cover Part D prescription drug payments when they should have been included in the daily hospice rate.
In a letter to CMS Administrator Seema Verma, Daniel Levinson, HHS Inspector General outlined some recommendations moving forward to further scrutinize hospice providers and ensure ethical and accurate billing. CMS did not “concur” for more than half of the recommendations made by OIG.
The report said, “we remain committed to our recommendations and will continue to work with CMS to promote their implementation.”
To read the full report, click here.
Check out NPR’s story here.