Hospice Organizations Call for Change as Legislators Monitor Program Integrity

Members of Congress are seeking answers from federal regulators about the integrity of the hospice program as industry advocacy groups call for further action.

Representatives Beth Van Dyne (R-Tex.) and Earl Blumenauer (D-Oregon) led a group of lawmakers who wrote to Chiquita Brooks-Lasur, administrator of America’s Medicare & Medicaid Services (CMS), asking them to be made aware of hospice fraud and abuse.

“Hospice can be an important part of patient care, but only if it works as intended,” the lawmakers wrote in the letter. “We are committed to working with CMS to ensure that this continues to be a safe option for patients while providing congressional oversight, and we look forward to hearing from you on these matters.”

Also today, four national hospice organizations met with LaSure to share their concerns and recommend possible solutions – LeadingAge, the National Association for Home and Hospice Care (NAHC), the National Hospice and Palliative Care Organization (NHPCO), and the National Health Partnership. and Hospice Innovation (NPHI).

Among the key concerns is a rash of new licensed hospice operators in several states, which some attribute to suspicious or unethical practices. The issue first came to attention late last year in California, but stakeholders have also raised concerns about vendors in Texas, Nevada, Arizona and Texas.

“Our goal, in partnership with members of Congress and CMS, is to ensure quality of care by enhancing the integrity of the hospice program,” said Ben Marcantonio, Chief Operating Officer and Acting CEO of NHPCO. “A series of recommendations, [the four groups] presented to the administrator by Brooks-LaSure, in conjunction with other national hospice groups and organizations across the country, clearly communicates our commitment to fraud and abuse prevention.”

In some cases, several hospices operated at the same address without a corresponding increase in the number of eligible patients. Some people also hold management positions in several of these hospices at the same time.

Arizona added 239 new Medicare-certified hospices between 2018 and 2022, representing 52% of all providers in the state. During this time, 56 new certified hospices appeared in Nevada, and 369 in Texas.

So far, California is the only state to take action on this issue, starting with a moratorium on new hospice licenses and an extensive review of California’s oversight processes.

At the federal level, NAHC, NHPCO, LeadingAge, and NPHI made 34 recommendations to CMS and congressional stakeholders regarding potential legislative and regulatory changes to increase oversight.

“Hospice reform must prioritize high-quality care, including the right services in the right quantity, and remove the opportunity for perpetrators to profit from older adults and their families,” said Katie Smith Sloan, President and CEO of LeadingAge, Hospice News. “By collaborating with other hospice provider groups, Congress and CMS, we hope meaningful change will occur.”

Collectively, the organizations expressed “strong” support for a targeted temporary moratorium on new Medicare-certified hospices in counties with “worrisome trends” in new licensed providers.

They also urged CMS to develop troubling criteria in the Medicare Certification application process that will require additional review by accrediting authorities or state inspectors before approval, as well as other changes to the Medicare Hospice Terms of Participation.

Today’s meeting with LaSure is the latest development in what is likely to be a long period of assessing the extent of the problem and developing possible solutions.

“On behalf of our members, we look forward to working with our national partners and legislators to advance meaningful change that will provide Medicare recipients and their families with the high-quality end-of-life care they rightfully deserve,” said NPHI CEO Tom. Koutsoumpas in his statement.

While CMS has yet to announce specific actions regarding these new hospices, there are likely wheels at work behind the scenes to address the issue, NAHC President William A. Dombey said in an interview with Hospice News.

“We were very encouraged by the strong interest shown by the Brooks-LaSure administrator and the clear indication that CMS is already taking action to address some of the problem areas in a targeted and meaningful way,” Dombey said. “We look forward to continuing to work with our colleagues in the national hospice associations and policy makers to protect the integrity of hospice care and maintain access to life-saving hospice services for vulnerable patients and their loved ones.”

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