In late October 2009, the Office of Inspector General (OIG) released its Work Plan for the 2010 fiscal year. Not surprisingly, hospice continues to be an area of focus for the OIG in 2010. The OIG publishes its Work Plan annually and sets forth various projects that the six departments within the OIG will address through audits, evaluations or other compliance activities during the fiscal year. The Work Plan is one method through which the OIG achieves its operational mission “to protect program integrity and the well-being of program beneficiaries by detecting and preventing waste, fraud, and abuse; identifying opportunities to improve economy, efficiency, and effectiveness; and holding accountable those who do not meet program requirements or who violate Federal laws.” FY 2010 Work Plan, pg. i.
The specific hospice-related compliance activities that are included in this year’s Work Plan are as follows.
Physician Billing for Medicare Hospice Beneficiaries
The OIG will review the extent of Medicare Part B physician billing for services provided to Medicare hospice beneficiaries. This study is a follow-up to other recent OIG hospice studies and will determine the “frequency of and total expenditures for physician services under Part A and Part B for hospice beneficiaries,” as well as identify whether physicians double-billed Part A and Part B for physician services provided to hospice patients. This is considered to be “work in progress,” meaning that the results of the study will likely be published in a report to be issued this year.
Trends in Medicare Hospice Utilization
The OIG will evaluate Medicare Part A hospice claims to identify certain trends in utilization. This study may include an evaluation of the number, types and lengths of stay of diagnoses associated with hospice admissions, as well as geographic variations in hospice utilization and differences between for-profit and not-for-profit hospice providers. This study is considered a “new start,” meaning that a report will likely be issued in 2011.
Duplicate Drug Claims for Hospice Beneficiaries
In this study, the OIG will evaluate whether payments made under Part D, Medicare’s prescription drug program, are correct and not duplicated for hospice beneficiaries under Medicare Part A. Part D drug plans should not pay for drugs that are covered under Part A or Part B. The OIG will also determine the extent of Part D duplication, if any, and identify measures to prevent such duplicate payments. The utilization study is also considered a work in progress.
As noted in the Medicare Payment and Advisory Commission’s (MedPAC) 2010 Report to the Congress (2010 Report) published in March 2010, Medicare spending for hospice services has “nearly quadrupled between 2000 and 2008, reflecting more beneficiaries enrolled in hospice and longer lengths of stay.” In addition, approximately 40% of Medicare decedents used hospice in 2008, compared to 23% in 2000. The substantial growth in hospice Medicare expenditures, claims and the number of hospice providers over the past several years has undoubtedly increased the likelihood of duplicate Medicare payments as well as other billing errors, resulting in improper Medicare payments. As a result, the OIG will most likely continue to include hospices in its work plans in the future. In fact, MedPAC recommended in the 2010 Report (as it also recommended in its 2009 Report to the Congress) that the secretary of the Department of Health and Human Services should direct the OIG to investigate:
- The prevalence of financial relationships between hospices and long-term care facilities
- Differences in patterns of nursing home referrals to hospice
- The appropriateness of enrollment practices for hospice with unusual utilization practices, such as a high frequency of very long stays
- The appropriateness of hospice marketing and admission practices
You should pay close attention to your billing practices and ensure that duplicate claims for hospice services, as well as claims containing other types of billing errors, are not being submitted. This will involve educating your vendors and other business associates of the services and supplies that are included in the Medicare hospice benefit and not separately billed. In addition, evaluating your length of stay, admission and marketing practices now may help prevent problems in the future as the OIG continues its focus on hospice.