NHPCO Meets with CMS on Program Integrity Recommendations, Six-Month Update

NHPCO

Summary at a Glance

Yesterday, July 12, NHPCO met with the Centers for Medicare and Medicaid Services (CMS) regarding the ongoing fraudulent hospice activity, focused but not limited to activity in Arizona, California, Nevada, and Texas. CMS was represented by staff from the Office of Legislative Affairs, Center for Clinical Standards and Quality, Provider Enrollment, and the Center for Program Integrity. Congressman Blumenauer (D-OR), who has been a leading congressional voice on hospice issues, participated in the meeting. Representatives from the National Association of Home Care and Hospice, LeadingAge, and the National Partnership for Healthcare and Hospice Innovation also joined the meeting.

CMS provided the following updates on its program integrity efforts: 

1.     National Site Visit Project: Beginning earlier this year, CMS began a project to visit all 7,000 hospices across the country to deactivate non-functioning or shell hospices. CMS is close to finishing this project and will release more information about the results upon completion.

2.     Enhanced Oversight: Starting today, July 13, 2023, CMS has implemented a “provisional period of enhanced oversight for hospice providers in Arizona, California, Nevada, and Texas.” This applies to any new hospice, a hospice submitting a change of ownership (CHOW), or a hospice undergoing a 100% ownership change that doesn’t fall under a CHOW, as described in MLN7867599 - Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, & Texas (cms.gov). Enhanced oversight will last anywhere from 30 days to one year and can include prepayment reviews, additional visits for providers not billing, and possible deactivation of the hospice’s provider number.

3.     Hospice + HH Rules: CMS staff highlighted a number of provisions in both the Fiscal Year 2024 Hospice Wage Index proposed rule and the Calendar Year 2024 Home Health proposed rule, aimed at combating fraud. NHPCO has published detailed analyses of each proposed rule referenced here.

4.     Hospice 90 Day Stay Review: In response to concerns about beneficiaries who do not qualify for hospice being admitted by fraudulent organizations, CMS is conducting a small pilot project with post-payment review of beneficiaries with a stay longer than 90 days. The goal of review is to target patients who should not have been admitted to hospice at all, covering billing between January 1 and December 31, 2021. CMS has contracted with the Supplemental Medical Review Contractor Noridian, which describes the project and the diagnosis codes it will be reviewing.

Of the 34 program integrity recommendations that NHPCO and other national stakeholder groups submitted to CMS Administrator Chiquita Brooks-LaSure in January of this year, CMS or Office of Inspector General (OIG) has acted on 17 of those recommendations. These four national hospice organizations will continue to work together and with other partners to drive solutions to stop the growth of fraudulent hospices and strengthen the hospice Medicare certification and survey process.