Hospices Should Improve Their Election Statements and Certifications of Terminal Illness

Medicare hospice care is intended to help terminally ill beneficiaries continue life with minimal disruptions and to support beneficiaries' families and other caregivers. Two key requirements of the Medicare hospice benefit are for the beneficiary to sign an election statement and for a physician to certify the beneficiary as terminally ill. Together, the election statement and certification of terminal illness provide critical safeguards to ensure that the beneficiary understands the hospice benefit and that the physician is involved in determining whether the beneficiary is appropriate for hospice care. However, previous OIG work has raised concerns that some election statements used by hospices are misleading and that physicians are sometimes not involved in care planning and may rarely see beneficiaries. Also, OIG has investigated numerous cases in which hospices submitted fraudulent claims for patients who were not appropriate for hospice care. This report assesses both hospice election statements and certifications of terminal illness.