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OIG report on hospice general inpatient care

04 April 2016

On Thursday March 31, 2016, the HHS Office of Inspector General released a report on the use and misuse of hospice inpatient care in the Medicare Hospice Benefit.

The HHS Office of Inspector General report, "Hospices Inappropriately Billed Medicare Over $250 Million for General Inpatient Care" states that: "Medicare inappropriately paid hospices $268.1 million for GIP in 2012. The inappropriate payments represent 26 percent of the $1.0 billion paid to hospices for GIP stays in 2012. For the vast majority of inappropriate GIP stays, the hospice should have billed for routine home care instead of GIP.”

In their description of the reasons for doing this study, the OIG states “Recent investigations by the Office of Inspector General have shown a number of instances in which hospices inappropriately billed Medicare for hospice general inpatient care (GIP). Misuse of GIP includes care being billed but not provided and beneficiaries receiving care they do not need.”  It is clear that the provision of hospice general inpatient care continues to be an area of focus and scrutiny. 

Hospices should carefully read the six recommendations and take steps to take to ensure compliance.

OIG Issues the Report and a Podcast about the Report - March 31, 2015 

Recommendations

In its report, the OIG recommends the following to CMS in response to their report:

1.     Increase its oversight of hospice GIP claims and review Part D payments for drugs for hospice beneficiaries.

2.     Ensure that a physician is involved in the decision to use GIP.

3.     Conduct prepayment reviews for lengthy GIP stays.

4.     Increase surveyor efforts to ensure that hospices meet care planning requirements.

5.     Establish additional enforcement remedies for poor hospice performance.

6.     Follow up on inappropriate GIP stays, inappropriate Part D payments, and hospices that provided poor-quality care.

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NHPCO Members:  Access a detailed NHPCO analysis of the OIG Report.

Addition commentary by NHPCO is available on ehospiceUSA, "NHPCO comments on OIG report."

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