Lawmakers, Regulators Push CMS for Greater Hospice Program Oversight

McKnight’s Home Care / By Adam Healy
 
The Centers for Medicare & Medicaid Services is facing mounting pressure from lawmakers and regulators to improve hospice program integrity. 
 
In a letter sent last week to the Centers for Medicare & Medicaid Services, 38 House representatives pointed out “instances of pervasive fraud and abuse” plaguing the Medicare hospice program. Though CMS has taken action against bad actors — notably through a period of enhanced oversight in four states — the lawmakers said more could be done.
 
“CMS has taken positive steps to increase its oversight of hospice programs,” they wrote. “However, we are deeply concerned by new reports indicating many potentially fraudulent hospices are continuing to bill Medicare and CMS is still enrolling suspicious new providers into the program.”
 
They asked CMS to explain the ways in which its oversight measures have addressed hospice fraud and abuse, and gave the agency a May 31 deadline to respond. 
 
Providers agree
 
The National Hospice and Palliative Care Organization described the letter as a “significant next step in holding CMS accountable for addressing the rising level of fraud and abuse by bad actors within the Medicare hospice benefit.”
 
“CMS must take decisive action against bad actors tarnishing the reputation of hospice care,” Logan Hoover, NHPCO’s vice president of policy and government relations, said in a statement. “This concerted effort, driven by our congressional allies, builds upon nearly two years of grassroots, policy and regulatory initiatives aimed at combating fraudulent practices within hospice care.”
 
GAO findings
 
Meanwhile, a recent report by the Government Accountability Office found that, as of May 2023, roughly 10% of hospices were overdue for a survey. These surveys are supposed to be conducted every three years. Of the overdue hospices, 10% had not been surveyed in more than six years.
 
The report also noted that CMS had only fully implemented five of the eight hospice oversight provisions mandated by the Consolidated Appropriations Act of 2021. GAO recommended CMS take action to fully implement the three outstanding oversight measures.
 
CMS said the COVID-19 public health emergency resulted in the need to reprioritize surveying activities. Still, the lawmakers pointed out that “longstanding hospice quality of care issues that need to be addressed,” according to their letter.