In a world where compassionate care for terminally ill patients and their families should be the utmost priority, it’s disheartening to learn that some hospices have been exploiting the system for financial gain. This alarming issue has caught the attention of the Centers for Medicare & Medicaid Services (CMS), leading to a renewed commitment to protect the integrity of the Medicare program. In this blog post, we’ll delve into the actions taken by CMS to address benefit integrity issues related to hospice care.
The Essence of Hospice Care
At its core, hospice care provides comfort, support, and dignity to individuals facing terminal illnesses and their families. Specially trained professionals and caregivers offer palliative care at home, aiming to address not only the physical needs of patients but also their emotional, social, and spiritual well-being.
The Dark Side of Hospice Care
Sadly, recent revelations have exposed a darker side of hospice care. Media reports and CMS research have uncovered instances of hospices certifying patients for hospice care who were not terminally ill and providing minimal to no services. These practices have led to a surge in potentially fraudulent hospices, particularly in states like Arizona, California, Nevada, and Texas. Some of these hospices even operate under non-operational addresses, further complicating the issue.
CMS’s Proactive Approach
CMS has taken decisive action to combat these benefit integrity issues. A nationwide hospice site visit project was initiated, involving unannounced visits to every Medicare-enrolled hospice. The aim was to ensure the operational status of hospices at their listed addresses. Hospices failing to meet these criteria faced the revocation of Medicare billing privileges.
Results and Future Steps
The site visit initiative has yielded promising results, with nearly 400 hospices under consideration for potential administrative action. CMS’s commitment extends to implementing enhanced oversight measures in high-risk states. Moreover, a pilot project will review hospice claims within the first 90 days of care, helping determine if claims align with eligible patients’ needs.
Regulatory Changes
CMS has proposed regulatory changes, some of which were suggested by the hospice industry itself. These changes include prohibiting the transfer of provider agreements, clarifying the definition of “Managing Employee,” and introducing a hospice Special Focus Program (SFP) for poor-performing hospices.
Enhancing Physician Qualifications
CMS now screens hospice-certifying physicians to further bolster integrity to ensure they are qualified to treat Medicare beneficiaries.
Quality Assurance
Quality assurance measures have been enhanced with multidisciplinary survey teams, the prohibition of surveyor conflicts of interest, and standardized survey deficiency reporting.
Transparency for Patients
CMS aims to provide patients and their families more information and transparency by publicly posting survey information on Care Compare.
Conclusion
CMS’s dedication to addressing benefit integrity issues in hospice care is commendable. By safeguarding Medicare, CMS ensures that taxpayer dollars are spent on high-quality, necessary care for vulnerable beneficiaries during their end-of-life journey. This ongoing effort underscores the importance of compassion, transparency, and integrity in healthcare, especially hospice car.
Read the full article about Hospice Fraud at CMS.gov
