HOSPICES: FEDS CRACK DOWN ON “IMPROPER” MEDICARE BILLINGS
Auditors from the Department of Health and Human Services'This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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
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).