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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Report Number
OEI-02-16-00570
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.

Report Type
Inspection / Evaluation
Agency Wide
Yes
Number of Recommendations
15
Additional Details
https://oig.hhs.gov/oei/reports/oei-02-16-00570.asp

Open Recommendations

This report has 14 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
5643 Yes $0 $0

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;

5645 Yes $0 $0

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;

5648 Yes $0 $0

CMS should include on Hospice Compare deficiency data from surveys, including information about complaints filed and resulting deficiencies;

5642 Yes $0 $0

CMS should take appropriate actions to follow up with hospices that engage in practices or have characteristics that raise concerns;

5640 Yes $0 $0

CMS should ensure that a physician is involved in the decisions to start and continue general inpatient care;

5641 Yes $0 $0

CMS should analyze claims data to identify hospices that engage in practices or have characteristics that raise concerns;

5644 Yes $0 $0

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;

5637 Yes $0 $0

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

5638 Yes $0 $0

CMS should develop other claims-based information and include it on Hospice Compare

5647 Yes $0 $0

CMS should adjust payments based on these analyses, if appropriate, to ensure that the payment system is aligned with beneficiary needs and quality of care

5646 Yes $0 $0

CMS should assess the current payment system to determine what changes may be needed to tie payments to beneficiaries’ care needs and quality of care to ensure that services rendered adequately serve beneficiaries’ needs;

5649 Yes $0 $0

CMS should modify the payments for hospice care in nursing facilities.

5639 Yes $0 $0

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;

5635 No $0 $0

CMS should analyze claims data to inform the survey process.

Department of Health & Human Services OIG

United States