Where To Report Waste

Fraud, Abuse, Or Retaliation

Medicare Improperly Paid Suppliers an Estimated $117 Million Over 4 Years for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided to Hospice Beneficiaries

Submitting OIG:

Department of Health & Human Services OIG

Date Issued:

Tuesday, November 16, 2021

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

A-09-20-03026

Component, if applicable:

Centers for Medicare & Medicaid Services

Type of Report:

Audit

Questioned Costs:

$0

Funds for Better Use:

$116,904,022

Number of Recommendations:

5

Related Open Recommendations

Recommendation Number	Recommendation Status	Significant Recommendation	Additional Details
271265	Open	No
Implement a postpayment edit process to detect claims submitted by suppliers processed before a beneficiary's notice of election of hospice care is processed in the CWF, and instruct the DME Medicare contractors to deny DMEPOS claims identified by the edit process if they do no have the GW modifier.
271267	Open	No
Study the feasibility of including palliative items and services not related to a beneficiary's terminal illness and related conditions within the hospice per diem. Such a requirement would eliminate the need for Medicare to make additional payments for these services consistent with CMS's longstanding position that payments for services unrelated to a beneficiary's terminal illness and related conditions should be exceptional, unusual, and rare given the comprehensive nature of the services covered under the Medicare hospice benefit. In analyzing the feasibility of such a change, CMS could consider: (1) beneficiary access to care, (2) administrative costs, (3) appropriate adjustments to the per diem rates to reflect the higher costs associated with providing hospice services, and (4) possible improvement of coordination of care.