HOSPICES: FEDS CRACK DOWN ON “IMPROPER” MEDICARE BILLINGS

      Auditors from the Department of Health and Human Services'
 Inspector General's office are "cracking down" on hospices that
 receive Medicare reimbursements for patients who are not "on the
 brink of death," WALL STREET JOURNAL reports.  The federal
 government is seeking repayments from hospices in California,
 Florida, Illinois, New York and Texas involving thousands of
 cases which it says resulted in "improper Medicare payments." 
 Only patients who have been certified by a doctor to have six
 months or less to live qualify for Medicare reimbursement for
 hospice care.  The government has already requested $18.8 million
 in repayments from two Florida hospices, and is "in the midst" of
 a less comprehensive review of 36 other facilities for terminally
 ill patients.  Medicare spent $1.85 billion on hospice care in
 the fiscal year ending September 30, 1995, up 41% from the year
 before. 
      THE STORY:  Auditors contend that their review of patient
 medical charts "raises questions in some cases whether patients
 were sick enough to qualify for hospice care."  However, hospice
 industry executives have challenged that assertion.  Mary Labyak,
 president of Largo, FL-based Hospice of the Florida Suncoast, a
 facility with nearly 300 cases under review, said, "There is
 overwhelming evidence that these people needed hospice care. 
 We've reviewed every case, and we feel we would prevail in nearly
 all of them."  In addition, the hospice industry contends that
 the "crackdown could make patients and their doctors reluctant to
 seek special end-of-life care."  Jay Mahoney, president of the
 National Hospice Organization, said, "Our concern is that they're
 trying to establish a zero-tolerance standard, where we can't
 make any mistakes. ... We think that's a very difficult standard
 to meet."  Judy Berek, a fraud expert at the Health Care
 Financing Administration, said, "Is this a benefit so out of
 control that it should be wiped away?  Absolutely not.  But is
 this a case where we need to get bad providers under control? 
 Yes, it is" (Anders, 1/8).