Editor’s Note: The growth of Medicare Advantage as a program (it accounts for a third of Medicare enrollees and spending), and the 9.3% difference in hospitalization rates between MA and fee-for-service has been cited as a good sign for the future of healthcare. CLICK HERE and let us show how BHM’s economically maintain turn-around times and accuracy for new members.

The Medicare hospice program is valuable to beneficiaries at the end of life, but it’s also vulnerable to fraud and poor care, according to a recent report from HHS’ Office of Inspector General.

The report examined vulnerabilities of the program and provided recommendations for combating them.

Medicare Part DCMS data showed Medicare spending for hospice care rose 81 percent between 2006 and 2016, from $9.2. billion to $16.7 billion. During that same period, the number of hospices rose 43 percent, and the number of Medicare beneficiaries receiving hospice care climbed 53 percent.

But the OIG said it found hospices sometimes provide poor care and failed to manage symptoms or medications. The OIG also found CMS does not provide beneficiaries with comprehensive information about hospice quality to make the most informed care decision.

The OIG said some hospices engage in inappropriate billing, such as charging for a high-cost, unnecessary level of care, which costs Medicare hundreds of millions of dollars.

There are also fraud schemes where beneficiaries who are not eligible for hospice care are enrolled, as well as fraud schemes where billing occurs for care that never took place.

Additionally, the existing payment system “creates incentives for hospices to minimize their services and seek beneficiaries who have uncomplicated needs,” the OIG said. “Within each level of care, a hospice is paid for every day a beneficiary is in its care, regardless of the quantity or quality of services provided on that day. While CMS has made some changes to payments, the underlying structure of the payment system remains unchanged.”

Based on its findings, the OIG recommended CMS “seek statutory authority to establish additional remedies for hospices with poor performance,” as well as “develop and disseminate additional information on hospices, including complaint investigations.”

The growth of Medicare Advantage as a program (it accounts for a third of Medicare enrollees and spending), and the 9.3% difference in hospitalization rates between MA and fee-for-service has been cited as a good sign for the future of healthcare. CLICK HERE and let us show how BHM’s economically maintain turn-around times and accuracy for new members.