Apr 3, 2023 - Health

Medicare signals crackdown on hospice fraud

Illustration: Annelise Capossela/Axios

Medicare administrators are cracking down on hospice fraud, releasing a proposal to require physicians who order hospice services to be enrolled in or validly opted out of Medicare in order to get paid.

Why it matters: Lawmakers are concerned about hospice fraud and want to see CMS step up to curb it.

  • Reps. Beth Van Duyne (R-Texas) and Earl Blumenauer (D-Ore.) wrote to CMS in February asking for a briefing on the agency’s oversight of the hospice program and any gaps in its oversight tools.
  • "CMS is looking closely at the hospice industry, as we have increasing concerns about fraud, waste and abuse in this space," the agency said in a fact sheet accompanying the proposal.

The proposal could strengthen the integrity of physician certifications for Medicare beneficiaries going into hospice services, CMS said in the rule.

  • CMS cites reports from the Office of Inspector General that some physicians have falsely certified beneficiaries as terminally ill in order to get them into hospice care.
  • ProPublica and the New Yorker late last year documented how the design of Medicare's hospice benefit and lax payment systems create incentives for hospices to cut corners and target patients who are not actually dying.
  • Medicare hospice spending exceeds $22 billion annually, per MedPAC.

Worth noting: CMS also proposed updating hospice payments by 2.8%, or $720 million, in fiscal year 2024 in the rule.

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