08/24/2023

CMS Targets 400 Hospices for ‘Administrative Action’

In a blog posted on August 22, Dara Corrigan, the Centers for Medicare & Medicaid Services (CMS) deputy administrator and director of the Center for Program Integrity, and Dora Hughes, CMS chief medical officer, Innovation Center, summarized benefit integrity issues that have come up related to Medicare hospice services and the actions CMS has and will take.

In “CMS is Taking Action to Address Benefit Integrity Issues Related to Hospice Care,” Corrigan and Hughes summarized findings that have emerged consistently in the media that some hospices are profiting from fraud “far too often.” They described CMS’s ambitious work to revitalize its hospice integrity strategy to focus on “identifying bad actors and address fraudulent activity to minimize impact on beneficiaries,” pointing especially to providers that are not operational at the address listed on their Medicare enrollment form.

They write that as of mid-August they identified 400 hospices that are being considered for potential administrative action, suggesting some will be able to demonstrate compliance by submitting a valid provider address, while those unable to do so “may be deactivated or revoked.” The blog post stopped short of listing the 400 providers, however. 

Because the problems have occurred in states with rapid growth in the number of potentially fraudulent hospices, CMS will implement a provisional period of enhanced oversight in four states: Arizona, California, Nevada, and Texas. CMS is also initiating a pilot project to review hospice claims following an individual’s first 90 days of hospice care. Other key actions are summarized in the blog.

LeadingAge has been part of a series of discussions with Corrigan and Hughes and other key CMS staff, including providing suggestions for steps CMS could take.