OIG Special Agents Sound Off on Hospice Fraud, CMS Rules

OIG Special Agents Sound Off on Hospice Fraud, CMS Rules
Home Health Care News
August 12, 2018
In one example of hospice fraud, a provider was caught billing for 17 days of general inpatient care for a 70-year-old Medicare beneficiary, though a caregiver had never even visited him. In another case, an owner (of) a hospice was found to be using recruiters to solicit and enroll beneficiaries for hospice care when they were not eligible in the first place. These are just a few of the many instances of billing fraud happening throughout the hospice industry, collectively costing the government hundreds of millions of dollars each year, according to the U.S. Department of Health and Human Services’ Office of Inspector General (OIG). As the main federal watchdog tasked with sniffing out misconduct related to Medicare, Medicaid and dozens of other government programs, OIG highlighted the cases in a scathing report released last month. While egregious, they only reveal a fraction of the Medicare hospice program’s numerous overall vulnerabilities, OIG officials and investigators—including a special agent who works undercover—told Home Health Care News during recent follow-up interviews. “Increasingly, we’re uncovering fraud schemes that are quite concerning,” Jodi Nudelman, regional inspector general for OIG, told HHCN. “Particularly when beneficiaries are just unaware that they’re even being enrolled in hospice.” Providers should know that OIG is on the lookout for illicit marketing maneuvers and unlawful physician kickback arrangements. They should equally note that OIG is trying to get the Centers of Medicare & Medicaid Service to crack down on the problems. … Besides improper billing, though, OIG has repeatedly found throughout the past decade that hospices do not always provide necessary services, sometimes even skimping on care over weekends or disregarding patients’ care plans. “We’ve found problems with the plan of care throughout our hospice work,” (Nancy) Harrison (deputy regional inspector general for OIG) said. “Let’s remember that the hospices are the ones that developed the plans of care, so, they basically set their own bar. If they can’t meet that, that’s very concerning.” … “We’ve found that hundreds of hospices only provide one level of care, routine home care, to their beneficiaries ... and there are four levels of care,” Harrison said. “When we see hospices only providing one level, it raises questions as to whether their beneficiaries have access to the care they need.” In 2012, hospices billed one-third of general inpatient care stays inappropriately, costing Medicare $268 million, according to OIG. Hospice fraud is on a spectrum, Derrick Jackson, a longtime HHS investor who currently holds the title of special agent in charge for OIG, told HHCN. Broadly, there is improper billing and similar administrative-level offenses on one end, he said, and then there’s the egregious cases that are possibly criminal on the other. All shades of fraud are important to OIG, but addressing the more flagrant cases are the top concern of its special agents, according to Jackson, who oversees the agency’s seven-state South East region, which is made up of Alabama, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee. Florida is not included in Jackson’s jurisdiction because it is its own region, being “ground zero” for health care fraud, he said. “We want to solve all of the hospice problem,” Jackson said. “But first we want to get the [hospice providers] that aren’t even close to legitimate, hospices that aren’t even providing any services. We’ve got to get those off the street.” Predatory recruiting has become a mounting concern for OIG as part of those efforts. … In Mississippi, hospice fraud and abuse has become such a problem that policymakers implemented a statewide moratorium preventing new hospices from opening. … In addition to predatory recruiting tactics, physician kickbacks in exchange for patient referrals are also a top concern for OIG. (Summary per Hospice News Today, 8/13/18.)