A new report by the Office of the Inspector General outlines the widespread utilization of hospice services covered under Medicare, while also highlighting the sytem’s flaws and some central vulnerabilities.
Because of the solace it can provide for people in the later stages of life, and their families, many Medicare beneficiaries opt for hospice care. In 2016 alone, Medicare paid $16.7 billion for hospice services utilized by 1.4 million individuals participating in the program.
Unfortunately, Medicare’ steep bills for hospice care do not always translate into quality care for its beneficiaries. The OIG found that hospices often left beneficiaries in pain, failed to provide medication, and responded poorly to a variety of health complications.
According to the report, Medicare beneficiaries are often left in the dark about crucial decisions impacting their care. In addition, hospices were found to routinely bill for the most expensive level of care without medical necessity.
Finally, the proliferation of fraudulent schemes is also affecting hospice care negatively. The OIG specifically referred to schemes involving “enrolling beneficiaries who are not eligible for hospice care,” and, “billing for services never provided.”
The report cites several cases of fraud.
Among them is that of a for-profit hospice in Mississippi, which billed the health care program for seven weeks to provide care for a beneficiary who needed only basic assistance for hygiene, feeding, and medication.
Nevertheless, the hospice managed to bill Medicare in the amount of $30,000.
Shockingly, the government largely attributes this type of misconduct to the current payment system, which, “creates incentives for hospices to minimize their services and seek beneficiaries who have uncomplicated needs.” As hospices get paid per day and per beneficiary, if a Medicare beneficiary is at a hospice, the facility is getting paid, whether the beneficiary needs extensive care or no care at all.
The report, entitled, “Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity,” does not only describe the current status of the program, but also makes 15 recommendations to improve it across seven key areas.
Increasing scrutiny when it comes to claim processing is one of the central recommendations included in the analysis. When potential violators are identified, the report recommends seeking, “statutory authority to establish additional remedies for hospices with poor performance.”
The OIG also advises Medicare to, “develop and disseminate additional information on hospices to help beneficiaries and their families and caregivers make informed choices about their care.” The information in question should include details about previous complaints and compliance issues, the Inspector General states.
In a nutshell, the OIG recommends that the Centers for Medicare and Medicaid Services should scrutinize more data to prevent fraud, and the results of that analysis should be promptly shared with the public.
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