Federal Reports

Recent investigations by the Office of Inspector General have shown a number of instances in which hospices inappropriately billed Medicare for hospice general inpatient care (GIP). Misuse of GIP includes care being billed but not provided and beneficiaries receiving care they do not need. Such misuse has human costs for this vulnerable population as well as financial costs for Medicare. The goals of hospice care are to help terminally ill beneficiaries with a life expectancy of 6 months or less to continue life with minimal disruptions and to support beneficiaries' families and other caregivers. The care is palliative, rather than curative. Hospices must establish an individualized plan of care for each beneficiary. GIP is the second most expensive level of hospice care and is intended to be short-term inpatient care for symptom management and pain control that cannot be handled in other settings.

ARC grant management system and available Basic Agency Monitoring Reports (BAMR) received from States administering construction related grants and consideration of ARC guidelines that permit States requests to revise or revoke commission approval of grants if the work intended to be assisted is not underway within 18 months of grant approval

To view the report, please click on the link below.

Cornerstone Hospital of Bossier City (The Hospital), in Bossier City, Louisiana, did not comply with Medicare requirements for billing Kwashiorkor on any of the 73 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have billed for other forms of malnutrition. For 25 of the inpatient claims, substituting a more appropriate diagnosis code produced no change in the diagnosis-related group or payment amount. However, for the remaining 48 inpatient claims, the errors resulted in overpayments of $322,000. The Hospital believes that all claims identified by the Office of Inspector General were appropriately submitted for payment.

Saint Louis University Hospital (the Hospital) (operating in Saint Louis, Missouri) complied with Medicare billing requirements for 243 of the 261 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 18 claims, resulting in net overpayments of $119,000 for calendar years 2011 and 2012. Specifically, 4 outpatient claims had billing errors, resulting in overpayments of over $65,000, and 14 inpatient claims had a billing error, resulting in net overpayments of over $53,000. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.