Hospice Oversight: 2024’s Most Impactful Regulatory Actions

Hospice News | By Jim Parker

The past year has seen a slew of regulatory developments aimed at improving quality and combatting fraud in the hospice industry.

The drive by regulators and members of Congress to strengthen oversight is fueled by two main factors. The first was two July 2019 reports on hospice quality from the Office of the Inspector General (OIG) in the U.S. Department of Health and Human Services (HHS). These spurred passage of the Helping Our Senior Population in Comfort Environments (HOSPICE) Act, which mandated the establishment of a hospice Special Focus Program (SFP), among other actions.

The second driving force was the emergence of fraudulent actors in the space in relatively large numbers, particularly concentrated in California, Nevada, Arizona and Texas.

Investigations have shown that potentially hundreds of newly licensed hospices have bilked Medicare of millions of dollars during the past several years, all while providing egregiously poor care or none at all. Some of these providers engaged in referral kickback schemes, enrolled patients who were not eligible for hospice and lied to them about being terminally ill.

In some instances, multiple hospices have been operating out of the same address without a corresponding increase in the population of eligible patients. Some individuals also hold management positions at several of these hospices simultaneously.

The Hospice Special Focus Program

Finalized in the U.S. Centers for Medicare & Medicaid Services’ (CMS) 2024 home health rule, the SFP is set for 2025 implementation.

Though the hospice community generally has voiced support for the program, many contend that the agency’s methodology for identifying hospices for the SFP is deeply flawed. Stakeholders, including hospice providers and members of Congress, have called on CMS to postpone the program and revise that algorithm.

The program will have the authority to impose enforcement remedies against hospices with poor performance based on its algorithm. Hospices flagged by the SFP also will be surveyed every six months rather than the current three-year cycle and could face monetary penalties or expulsion from the Medicare program. CMS will also make public the names of hospices selected for the SFP.

The program, set to begin Jan. 1, 2025, could potentially lead patients away from quality providers and into the arms of bad actors in the space, according to Dr. Steven Landers, newly appointed CEO of the National Alliance for Care at Home…

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