Hospice Providers Need To Tighten Their Compliance Plan

By Author: Jaun Paul
Total Articles: 53
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The Office of the Inspector General (OIG) is eyeing hospice agencies with over 12 areas on its watch list. As such, hospice providers need to tighten up their compliance plan in order to ensure it's covering all the bases. It has identified 28 total risk areas for abuse in hospice programs, but you should take special care when dealing with higher reimbursement levels.


The OIG has targeted hospice and nursing home arrangements for scrutiny because it believes these partnerships are vulnerable to fraud and abuse. It sees two practices as constituting potential kickbacks, which are:


The hospice offering free or below fair market value goods to induce SNF in order to refer patients to hospice.
The hospice providing staff at its expense to the SNF to perform duties otherwise performed by the SNF.
You could land in a tight spot if your hospice is providing GIP and routine home care in the nursing home and also offering continuous home care. Since continuous home care ...
... and GIP are so similar, you need to document really closely why the patient would be using GIP in place of continuous care.


Here is what you should take note of:


The OIG released a study examining compliance with Medicare coverage requirements for hospice patients in nursing facilities last winter. According to the report, 82 percent of hospice claims for beneficiaries in nursing facilities did not meet at least one Medicare coverage requirement. 81 percent of this did not meet at least one requirement relating to election statements, plan of care, services or certifications of terminal illness.


Although it remains unclear what action is going to follow based on this study, the time is right to take a look at documents and processes.


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