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OIG study: CMS, keep an eye on hospices in assisted living

February 16, 2015
by Sandra Hoban, Managing Editor
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A Jan. 13 study released by Department of Health and Human Services’ Office of Inspector General evaluated all Medicare hospice claims from 2007 to 2012. Its findings showed that because assisted living (AL) residents generally have less-complex medical issues, residents of hospice are provided more days than are patients at home or in skilled nursing facilities.

The report also notes that for-profit hospices receive more in Medicare reimbursement for each patient than nonprofit hospice organizations.

OIG has recommended that the Centers for Medicare & Medicaid Services (CMS) reduce incentives for hospices targeting AL residents having certain diagnoses that lead to extended care. The OIG study suggests that CMS keep a sharp eye on certain hospices, including for-profit hospices, “with a high percentage of patients receiving care over 180 days or patients with certain diagnoses.

With the specter of increased scrutiny, AL hospice providers should take certain steps now, according to the National Law Review:

  • Evaluate their data on AL residents to identify outlier or potentially unsupported distinctions from services provided in other settings.
  • Conduct internal compliance review as to the services provided to AL residents.

The advice is particularly warranted for hospices in AL facilities that fall near or in the high service category, according to the publication.

Related content:

OIG recommends 5 changes to Medicare hospice payment system

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