On March 30, 2016, the OIG released a report alleging that hospices billed one-third of hospice general inpatient care (GIP) stays inappropriately, costing Medicare $268 million in 2012.

According to the report, GIP is the second most expensive level of hospice care and is intended to be short-term inpatient care for symptom management and pain control that cannot be handled in other settings. The report claimed to find that (1) hospices commonly billed for GIP when the beneficiary did not have uncontrolled pain or unmanaged symptoms, (2) hospices were more likely to inappropriately bill for GIP provided in skilled nursing facilities than GIP provided in other settings, (3) Medicare sometimes paid twice for drugs because they were paid for under Part D when they should have been provided by the hospice and covered under the hospice daily payment rate, and (4) for-profit hospices were more likely than other hospices to inappropriately bill for GIP.  The report also claimed that hospices did not meet all care planning requirements for 85 percent of GIP stays and sometimes provided poor quality care. 

The report includes a number of recommendations to address the findings, including that CMS (1) increase its oversight of hospice GIP claims, (2) review Part D payments for drugs for hospice beneficiaries, and (3) conduct prepayment reviews for lengthy GIP stays.

The full report is available here.

Reporter, Kristin Roshelli, Houston, +1 713 751 3263, kroshelli@kslaw.com.