OIG to Initiate New Hospice Investigations and Audits

More than one year after two major hospice reports¹   raised concerns ranging from billing to patient safety, the U.S. Department of Health & Human Services Office of the Inspector General (OIG) continues its review of the hospice industry.

OIG will soon release reports addressing ways in which the hospice inpatient aggregate payment cap and payments made outside of the Medicare Hospice Benefit are calculated.  The office is also reviewing specific providers’ compliance efforts and Medicare payments for chronic disease management.  In addition, OIG is investigating potential issues throughout various healthcare sectors that have come to light during the COVID-19 pandemic.

Last year’s OIG reports garnered widespread attention and some criticism from the hospice industry.  The first report indicated that approximately 20% of hospices surveyed by regulators or accreditors between 2012 and 2016 had at least one condition-level deficiency that posed a serious safety risk.  A second report featured an in-depth discussion of twelve cases of alleged harm to hospice care beneficiaries with the goal of providing examples of vulnerabilities and prevention methods.  OIG examined state agency and accreditor survey findings as well as complaint data from 2012 through 2016, which covered nearly all U.S. hospice providers.

Since releasing those reports, OIG has continued to monitor progress on its recommendations to the U.S. Centers for Medicare & Medicaid Services (CMS) for strengthening hospice oversight and reevaluating compliance measures.  For example, CMS is making efforts to increase information available to healthcare consumers by featuring hospice complaint survey data on the Hospice Compare and the new Care Compare websites.  CMS is also analyzing claims and deficiency data to improve the survey and complaint processes.  OIG has also requested that CMS require hospices to report all instances of abuse or neglect, regardless of the responsibility or involvement of hospice staff.

For more information, please contact Jason E. Bring .

[1] U.S. Department of Health and Human Services Office of the Inspector General, OEI-02-17-0002, Hospice Deficiencies Pose Risks to Medicare Beneficiaries (July 2019), available at https://oig.hhs.gov/oei/reports/oei-02-17-00020.pdf?utm_source=summary-page&utm_medium=web&utm_campaign=OEI-02-17-00020-PDF; U.S. Department of Health and Human Services Office of the Inspector General, OEI-02-17-00021, Safeguards Must Be Strengthened To Protect Medicare Hospice Beneficiaries From Harm (July 2019), available at https://oig.hhs.gov/oei/reports/oei-02-17-00021.pdf?utm_source=summary-page&utm_medium=web&utm_campaign=OEI-02-17-00021-PDF.