On May 3, 2013, the Office of Inspector General (OIG) released a memorandum describing hospice general inpatient care (GIP) provided to Medicare patients in 2011, for which Medicare paid $1.1 billion. According to the memorandum, the OIG will be conducting an in-depth medical record review to evaluate the appropriateness of GIP provided by hospices. The study will be focused on the accuracy of reimbursement for GIP and the proportion of GIP provided in different settings, specifically Medicare-certified hospice inpatient units, hospitals, and skilled nursing facilities.
This ongoing study is a continuation of prior studies released by the OIG, which show that the amount of GIP services provided differs significantly depending on the setting. For example, hospices that have their own inpatient units provided GIP to 35% of their Medicare patients. In contrast, hospices that have to outsource GIP care sent only 12% of their Medicare beneficiaries to receive that care. Furthermore, hospices that provided GIP in their own inpatient units recorded 50% longer patient stays and three times the proportion of Medicare payments for GIP services than did hospices that have to outsource GIP care.
The memorandum states that the OIG will begin a new study which will use actual beneficiary medical records to determine the accuracy of reimbursement. In addition to its own investigations, the OIG advised CMS to ensure that the hospices not currently providing GIP are still providing beneficiaries with appropriate access to the types and amount of care needed at the end of their lives. These studies are part of OIG’s continuing investigations related to Medicare hospice care. In 2011, Medicare paid $13.7 billion for hospice services on behalf of 1.2 million beneficiaries, and both of those numbers are expected to increase with the aging of the baby boomer generation.
Despite this report not containing recommendations to CMS, as OIG reports typically include, the OIG intends to provide CMS with recommendations in a follow-up report after the OIG completes its medical record review. Once the OIG makes its recommendations to CMS, hospice providers can anticipate increased audit scrutiny surrounding hospice GIP, including the over-utilization of inpatient hospice stays for hospice providers that have their own inpatient units. The way hospice providers should respond to this increased scrutiny is to increase their compliance activities in this area.
Wachler & Associates healthcare attorneys regularly counsel providers, including hospice providers, in proactively addressing potential audit risk areas and defending providers against Medicare audits. If you or your healthcare entity need assistance in developing an effective compliance plan, or assistance in Medicare, Medicaid or third party payor audit defense, please contact our experienced healthcare attorneys at 248-544-0888.