According to a report released in 2012 by the U.S. Department of Health and Human Services and the DOJ, Medicare spending on hospice care for nursing home residents increased by 70% between 2005 and 2011. In 2011 alone, Medicare spent $13.7 million on hospice services in 2011. It should be no surprise in light of such exorbitant spending on hospice care that audits will increase in order to reduce health care costs and curtail fraud and abuse. In fact, the 2014 OIG Work Plan makes it readily apparent that the agency will be focused on (1) hospice services provided in assisted living facilities with special attention to the length of stay, levels of care, and common terminal illnesses; (2) hospice marketing, referrals, and anti-kickback in nursing home care; and (3) hospice inpatient care. Specifically, auditors are interested in reviewing:
- extensive lengths of stay;
- excessive units of physician services;
- credentials and qualifications;
- care plans; and
- beneficiary contributions.
If you are a provider of hospice care, the question is not if, but when, an auditor will show up at your door. Before that happens, you need to enact a comprehensive compliance program that addresses all targeted areas of concern, as expressed by the OIG, DOJ, and HHS. An audit can lead to hefty fines, burdensome corporate integrity agreements, exclusion from Medicare, or indictments. When you hear that knock upon the door, immediately contact your designated compliance officer and legal counsel, if necessary, to determine how to proceed.
Emily M. Hord
McBrayer, McGinnis, Leslie & Kirkland, PLLC