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We recommend that the Centers for Medicare & Medicaid Services take the following actions, which could have saved Medicare an estimated $190.1 million in payments made to acute-care hospitals for outpatient services provided to hospice enrollees and could have saved enrollees an estimated $43.6 million in deductibles and coinsurance that may have been incorrectly collected from them or from someone on their behalf during our audit period:

Educate acute-care hospitals to understand that each hospice enrollee's hospice election statement addendum is available on request, and educate hospices to provide the addendum if requested to help an acute-care hospital assess whether an outpatient service palliated or managed an enrollee's terminal illness and related conditions.

Questioned Costs
$0
Funds for Better Use
$0
Recommendation Status
Open
Source UUID
HHSOIG__Audit__2024-11-12__A-09-23-03024-25-A-09-011.02
Recommendation Number
25-A-09-011.02
Significant Recommendation
No