Hospice Fraud Back In The Spotlight, With New Data Also Raising Questions About Home Health Care

Home Health Care News | By Robert Holly
 
The number of hospice providers enrolled in the Medicare program in four states has skyrocketed over the past few years. The jaw-dropping spike, in turn, has triggered increased oversight efforts – some of which may not be having the desired effect.
A similar trend could be happening in home health care in one major county, U.S. Centers for Medicare & Medicaid Services (CMS) data suggests.
 
In hospice, the surge of new providers and potentially fraudulent activities has been concentrated in Arizona, California, Nevada and Texas. In home health care, it’s Los Angeles County.
 
After becoming aware of the data on new hospice openings and following a series of scathing media reports, CMS implemented a Special Focus Program (SFP), effective Jan. 1, while also finalizing a new rule forbidding change in majority ownership during the 36 months after initial Medicare enrollment, including acquisitions, stock transactions or mergers.
 
In August, the agency additionally announced it was considering administrative action against 400 hospices.
 
“Unfortunately, hospices are profiting from fraud at the expense of beneficiaries far too often,” CMS said at the time.
 
Meanwhile, some of the aforementioned states have pushed forward stronger rules and regulations, too. For example, in 2021, California passed two reform laws that included a moratorium on new hospice provider licenses until the state health department weeded out bad actors.
 
A California Department of Justice (CDOJ) report detailing the state’s history of lax oversight helped fuel that initiative. 
 
“The state’s weak controls have created the opportunity for large-scale fraud and abuse,” CDOJ indicated in its report.
 
Back in the spotlight
 
Hospice fraud and the related oversight efforts were back in the spotlight last week, when ProPublica reported that new hospices in California are still receiving Medicare certification with clear instances of fraud happening in the other states as well.
In one instance last year, 15 new hospices received Medicare certification, all operating from the same two-story building in Los Angeles, according to ProPublica.
 
In another: A location in Phoenix was approved for three new hospice licenses, all at the same location as dozens of other new providers in the previous two years.
According to a review of Medicare claims data shared with Home Health Care News and Hospice News, California had 102 newly enrolled hospices in 2023. In Arizona, the number of new hospices increased by 25 during the same period, while Texas and Nevada saw 72 and 25 new providers, respectively.
 
Across the board, no other state experienced an influx of more than 15 new hospices, with most states reporting single-digit enrollment figures.
 
In total, approximately 69% of all newly licensed hospices in 2023 were situated in Arizona, California, Nevada and Texas.

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Minor Hospice Cost Report Changes

The Health Group 

The U.S. Centers for Medicare and Medicaid Services (“CMS”) has released minor changes to the Hospice Cost & Data Report (“Cost Report”).

The changes are as follows:

• The Cost Report now provides for indication that the filing is a no Medicare utilization filing, if applicable.
• Effective beginning January 1, 2024, hospice accounting records should segregate the costs of marriage and family therapy services and mental health counseling services.  These costs are to be reported with other counseling services (line 36 of Worksheets A-1, A-2, A-3, and A-4).
• Cost Report Level 1 Edit – Worksheet S must identify the cost report submission as a full, low, or no utilization filing.
• Cost Report Level 2 Edit – Worksheet A, column 7, line 2 (Capital-Related Costs – Movable Equipment) must include a cost entry more than $0.

The Cost Report cannot be submitted electronically if the report contains any Level 1 Edits.