Hospices Overbilled Medicare by $268 Million in 2012


According to a report by the Health and Human Services’ Office of Inspector General, hospices overbilled Medicare by approximately $268 million in 2012. One of the common areas of overbilling was in the level of inpatient care. Twenty percent of inpatient stays did not require the level of care they were given, and were billed too high. Just under half of inpatient stays in skilled nursing facilities also saw incorrect billing, and often times these overbillings were in cases involving mental disorders, Alzheimer’s or ill-defined conditions.

Additionally, the report found that for-profit hospices were more likely than others to bill inappropriately. For-profit hospices billed inappropriately one and a half times more often than nonprofit hospices.

More from Becker’s Hospital Review:

Medicare often paid for drugs twice due to inappropriate billing. Medicare payments to hospices cover drugs for pain relief and symptom control related to terminal illnesses. However, the OIG found Medicare Part D also paid for more than half of the drugs used for pain relief and symptom control in hospice inpatient stays. Therefore, Medicare is paying twice for these drugs.

Hospices did not meet care planning requirements for the majority of inpatient stays. Each patient is required to have an individual plan of care in hospice and the plan of care must meet specific requirements. The report shows 72 percent of inpatient stays lacked at least one important element of the care plan. It also shows in about half of inpatient stays, not all the required members participated in developing the care plans. Most often a pastoral, counselor or social worker was missing, but in 12 percent of stays, physicians weren’t even involved, according to the report.

Lastly, hospices did not provide enough services in 9 percent of inpatient stays. In particular, hospices often did not provide sufficient nursing, physician or medical social services, and in some cases the hospices were unable to manage patient symptoms or medications, according to the report.

In response to the report, CMS Acting Administrator Andy Slavitt said in a statement that inpatient claims have remained flat over several years, according to a CMS analysis.

“CMS is also concerned that Medicare beneficiaries continue to have access to this important hospice service and CMS is working to improve appropriate use. As a result, CMS is developing a strategy that targets improper payments without unnecessarily increasing documentation and audit burden on legitimate providers,” he said.

A link to the full Health and Human Services report can be found here.


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