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Date: October 10, 1995 For Release: Immediately Contact: OIG Press Office, (202) 619-1142
"Medicare's hospice program was created as a compassionate and realistic alternative to conventional Medicare coverage for beneficiaries who have terminal illnesses," said HHS Secretary Donna E. Shalala in announcing the advisory bulletin. "The Clinton Administration will not tolerate cynical and fraudulent use of this benefit by any hospice program or health care provider."
Today's bulletin is part of "Operation Restore Trust," a special targeted effort launched by the Clinton Administration this year to attack fraud, waste and abuse in the Medicare and Medicaid programs. Within HHS, the Inspector General works with the Health Care Financing Administration and the Administration on Aging in carrying out "Operation Restore Trust" activities. Possible problems in the hospice program were uncovered through collaborative work by the inspector general and HCFA.
Under the hospice benefit, patients with a life expectancy of less than six months can enroll in hospice programs and receive care at home or in hospice facilities instead of receiving more traditional treatment in a hospital setting.
HHS Inspector General June Gibbs Brown said recent audits indicate that some providers may be improperly diagnosing patients as terminally ill and enrolling them in the hospice program. In addition, some hospice programs may be failing to deliver needed services that should be provided to patients, or discharging when expensive health services are needed.
"In the course of reviewing trends in Medicare's hospice program, we have learned of activities that should be of concern to beneficiaries who are in hospice or who are considering the option of hospice," Inspector General Brown said.
"These questionable practices primarily involve issues of hospice enrollment. Others involved in the Medicare program, including providers and health care workers, should also be alert to these activities," she said.
Recent audits released by the Office of Inspector General assessed the accuracy of beneficiary eligibility determinations and resultant Medicare reimbursements at several facilities. The OIG found that these facilities had eligibility determinations that were 70 percent and 77 percent incorrect. These facilities claimed Medicare reimbursements up to $2.7 million.
At one facility auditors reviewed 111 of 288 patients served. The 111 eligibility determinations reviewed included active patients who had more than 210 days of service and all patients that had been discharged from the hospice for reasons other than death.
The initial audits, conducted in Puerto Rico, were carried out with United Government Services, the Medicare intermediary for that area. The inspector general said follow-up audits are being carried out in the five "Operation Restore Trust" target states: New York, Florida, Texas, Illinois and California.
"The Medicare program will continue to work with our contractors and the inspector general to assure that any abuse in the hospice program is quickly identified and stopped," said Bruce Vladeck, HCFA administrator.
The bulletin highlights several ways some hospice providers apparently maximize their Medicare reimbursement. These include: