Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity: An OIG Portfolio

Submitting OIG:

Department of Health & Human Services OIG

Report Description:

OIG is committed to ensuring that beneficiaries receive quality care and to safeguarding the hospice benefit. OIG has produced numerous evaluations and audits of the hospice program, including in-depth looks at specific levels of care and settings. OIG has also conducted criminal and civil investigations of hospice providers, leading to the conviction of individuals, monetary penalties, and civil False Claims Act settlements. Through this extensive work, OIG has identified vulnerabilities in the program. This portfolio highlights key vulnerabilities and presents recommendations for protecting beneficiaries and improving the program.

Date Issued:

Monday, July 30, 2018

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

OEI-02-16-00570

Component, if applicable:

Centers for Medicare & Medicaid Services

Location(s):

Agency-Wide

Type of Report:

Inspection / Evaluation

Number of Recommendations:

View Document:

Attachment	Size
oei-02-16-00570.pdf	1.43 MB

Additional Details Link:

https://oig.hhs.gov/oei/reports/oei-02-16-00570.asp

Related Open Recommendations

Recommendation Number	Recommendation Status	Significant Recommendation
5635	Open	No
CMS should analyze claims data to inform the survey process.
5637	Open	Yes
CMS should seek statutory authority to establish additional remedies for hospices with poor performance
5638	Open	Yes
CMS should develop other claims-based information and include it on Hospice Compare
5639	Open	Yes
CMS should work with its partners, such as hospitals and caregiver groups, to make available consumer-friendly information explaining the hospice benefit to beneficiaries and their families and caregivers;
5640	Open	Yes
CMS should ensure that a physician is involved in the decisions to start and continue general inpatient care;
5641	Open	Yes
CMS should analyze claims data to identify hospices that engage in practices or have characteristics that raise concerns;
5642	Open	Yes
CMS should take appropriate actions to follow up with hospices that engage in practices or have characteristics that raise concerns;
5643	Open	Yes
CMS should increase oversight of general inpatient care claims and focus particularly on general inpatient care provided in SNFs, given the higher rate at which these stays were inappropriate;
5644	Open	Yes
CMS should implement a comprehensive prepayment review strategy to address lengthy general inpatient care stays so that beneficiaries do not have to endure unnecessarily long periods of time in which their pain and symptoms are not controlled;
5645	Open	Yes
CMS should develop and execute a strategy to work directly with hospices to ensure that they are providing drugs covered under the hospice benefit as necessary and that the cost of drugs covered under the benefit are not inappropriately shifted to Part D;

Recommendation Number

Recommendation Status

Significant Recommendation

Additional Details

5635

Open

CMS should analyze claims data to inform the survey process.

5637

Open

Yes

CMS should seek statutory authority to establish additional remedies for hospices with poor performance

5638