New report from the OIG

Categories: Policy.

On September 15, 2016, the Department of Health and Human Services Office of the Inspector General (OIG) released a report on hospice care that focused on findings in two areas: election statements, and physician certification and attestation. 

The OIG’s attention was anticipated and NHPCO’s Health Policy Team has done an initial assessment of the report findings – as is customary – and will use this information to inform our advocacy strategy and add to our existing regulatory resources and educational materials that promote the delivery of high quality care to individuals who are medically eligible to receive hospice services.  

Hospice organizations typically employ a very robust intake process that involves multiple conversations and interactions between the hospice team, patients and their caregivers. While these conversations and interactions are generally very thorough, the OIG’s report highlights several examples where hospices were imprecise or overly-general in their hospice election paperwork and fell short when filing their physician narratives. 

For example, 20 percent of hospice elections in the sample failed to specify that beneficiaries were electing the *Medicare* hospice benefit (as opposed to a managed care or Medicaid benefit). Others were too general in their statements, suggesting, for example, that beneficiaries waive *all* other Medicare benefits.  In fact, hospice patients can continue to access Medicare benefits for conditions unrelated to their terminal illness.

“It is important to note that OIG found that some inconsistencies might stem from discrepancies between hospice statute, regulations and the CMS manual,” said Jonathan Keyserling, NHPCO senior vice president for health policy. 

NHPCO agrees with OIG’s common-sense recommendations to CMS to address these issues. In fact, NHPCO recently worked with one Medicare Administrative Contractor on model text for election statements, and provides training and assistance to our members to ensure that their election processes, physician practices and administrative functions are compliant with CMS regulations. 

Preceding the release of the report by the OIG, an article published by The Washington Post, “How tens of thousands of patients who weren’t actually dying wound up on hospice care,” uses information from the OIG report and makes some broad-based conclusions that inaccurately imply gross levels of fraud. While media attention on issues of compliance in the field is understandable, NHPCO is concerned that patients and families who might see this article might be frightened by the sensationalized headline.

NHPCO members will find a Regulatory Alert available online.  In addition, NHPCO has a detailed compliance guide on the hospice election process that is available online for members.