In its continued effort to curb fraud and abuse in the hospice industry, on Aug. 22, 2023, the Centers for Medicare & Medicaid Services (CMS) announced it was making unannounced site visits to every Medicare-enrolled hospice nationwide.
The goal of the site visits was to ensure that each hospice was active and operational at the address listed on the Medicare enrollment forms. As of mid-August 2023, CMS has conducted more than 7,000 unannounced site visits, resulting in nearly 400 hospices being considered for potential administrative action, which could include deactivation or revocation of Medicare billing privileges.
In addition, CMS is implementing a provisional period of enhanced oversight in four states noted for their rapid growth in the number of potentially fraudulent hospices: Arizona, California, Nevada and Texas. During this period, CMS will conduct a medical review before making payments on claims submitted by newly enrolled hospices. CMS also announced a new initiative to review hospice claims earlier in an individual patient’s length of stay — specifically, after an individual’s first 90 days of hospice care. The goal of the project is to inform future medical review activities and better determine whether hospices are submitting Medicare claims for patients ineligible for the hospice benefit.
These surveys and new oversight policies are in addition to the CMS’ proposed regulatory changes from June, further discussed in a recent client alert, and the recently finalized requirement that hospice-certifying physicians be qualified to treat Medicare beneficiaries. With recent changes made by CMS in addressing fraud and abuse concerns in the hospice sector, it is clear that CMS is:
- increasing oversight of hospices;
- leveraging audits and site visits to identify problematic actors;
- using its administrative authority to propose regulatory changes intended to strengthen the integrity of the hospice benefit; and
- developing and utilizing data analytics tools to identify and probe for medical necessity and billing concerns.
A full copy of the CMS announcement can be accessed on CMS’ blog at CMS.gov. If you anticipate being affected by CMS’ latest announcement and/or would like additional guidance on CMS’ latest hospice oversight policies and best practices, please contact the authors.