Federal Reports

Why OIG Did This AuditThe Medicare hospice benefit allows providers to claim Medicare reimbursement for hospice services provided to individuals with a life expectancy of 6 months or less who have elected hospice care. Previous OIG audits and evaluations found that Medicare inappropriately paid for hospice services that did not meet certain Medicare requirements.How OIG Did This AuditOur audit covered 6,142 claims for which Mission (located in San Mateo, California) received Medicare reimbursement of about $37 million for hospice services provided from October 1, 2015, through September 30, 2017. We reviewed a random sample of 100 claims. We evaluated compliance with selected Medicare billing requirements and submitted these sampled claims and the associated medical records to an independent medical review contractor to determine whether the services met coverage, medical necessity, and coding requirements.

A Clerk based in Bear, Delaware, was terminated on July 8, 2021, for failing to report his December 2020 arrest for drug-related charges. Company policy requires employees to notify the company as soon as practicable after an arrest, or within 48 hours after being released from incarceration. The employee’s disclosure occurred nearly six months later, and only after he was formally asked about the arrest during the course of our investigation.