The Department of Health and Human Services, Office of Inspector General (OIG) recently released two reports on the Medicare hospice benefit, identifying key vulnerabilities within the program and outlining opportunities for the Centers for Medicare & Medicaid Services (CMS) to better protect beneficiaries.
The reports are extremely troubling: from 2012 to 2016, the majority of hospices—87%—had at least one deficiency that negatively impacted the care being provided to people with Medicare, and some beneficiaries were seriously harmed as result. Instances of poor or inappropriate care include failing to respond to reports of abuse and ineffectively managing symptoms or medications, leaving beneficiaries in pain for many days.
The investigations revealed significant compliance and management issues that may be contributing to these unacceptable levels of care and inadequate beneficiary safeguards, such as improperly vetting staff, mismanaging services and care plans, and failing to provide beneficiaries with the information they need to make informed decisions about their care.
The OIG observes that the current payment system, which creates incentives for hospices to minimize their services and seek beneficiaries who have uncomplicated needs, may also be contributing to these pervasive deficiencies.
Further, the reports conclude that hospices’ inappropriate billing practices are costing Medicare hundreds of millions of dollars, in part to due to fraudulent schemes and practices—such as enrolling beneficiaries who are not eligible for hospice care, charging Medicare for expensive and unnecessary serves, and even billing for services never provided.
To address these extremely troubling quality, management, and care provision issues, OIG recommends that CMS make a number of improvements. These remedies include taking steps to strengthen oversight efforts, compliance tools, and enforcement practices; better educating and informing beneficiaries and their families about the hospice benefit; correcting misaligned payment incentives; and better training staff, more effectively promoting physician accountability, and making it easier to report signs of abuse and neglect.
Medicare Rights recognizes that many hospice programs meet Medicare requirements and provide high-quality care. However, those that fall short must not be allowed to continue to do so. We strongly urge CMS to adopt the OIG’s recommendations and any others necessary to meaningfully and immediately improve the care being provided through Medicare’s hospice benefit, better protect Medicare beneficiaries, and hold hospices accountable for deficiencies in their programs.