OIG: Hospice Nurses Failed to Assess Aides in 99,000 Cases

Hospice nurses did not perform a home visit to assess the quality of care provided by hospice aides in an estimated 99,000 instances during 2016, according to a new report from the U.S. Department of Health & Human Services Office of the Inspector General (OIG). In another 5,000 cases the visits were not documented properly. 

The U.S. Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs) for hospices require a registered nurse to visit the site of care to assess the quality of care and services provided by hospice aides and to document the visits in a many consistent with regulations.

“These deficiencies occurred because of hospices’ lack of oversight, scheduling errors, employee turnover, and the registered nurses not being aware of the 14-day supervisory visit requirement,” OIG indicated in the report. “As a result, there was no assurance that beneficiaries admitted to those hospices received the appropriate care while in hospice care.”


OIG conducted an audit of nearly 189,000 high-risk registered nurse visits date pairs between Jan. 1 and Dec. 31, 2016. The agency defined “date pair” as two visits by a registered nurse that occurred more than 14 days apart.

The OIG has had its eye fixed on the hospice industry during 2019. In July, an OIG report indicated that about 20% of hospices surveyed by regulators or accreditors between 2012 and 2016 had a condition-level deficiency that posed a serious safety risk. A second report discussed 12 examples of those deficiencies in-depth. OIG examined state agency and accreditor survey findings as well as complaint data from 2012 through 2016. Regulators and accreditors surveyed nearly all hospice providers in the nation during those years.

The reports garnered widespread media attention and elicited strong reactions from hospice organizations. In addition to bringing attention to safety incidents in hospices, the reports called into question the effectiveness of CMS’ enforcement strategies.


A subsequent report released in August examined whether the Medicare Part D program paid for drugs during 2016 that should have otherwise been paid for by hospice organizations under the Medicare Part A hospice benefit. Broadly, Medicare Part D is an optional program to help Medicare beneficiaries pay for self-administered prescription drugs through prescription drug insurance premiums.

After reviewing hundreds of Medicare records and following up with hospice organizations, OIG found that Part D ended up covering more than $160 million in drugs hospices should have picked up themselves.

As with the previous OIG reports this year, the new report on nurse visits came with recommendations for stepped up oversight of hospices by CMS.

OIG called on CMS to require state agencies and accreditation bodies to bolster their oversight efforts related to the 14-day requirement in particular. The report also recommended that CMS boots education efforts for hospices related to this issue and to make the associated CoP a quality measure.

“As with previous reports from the OIG, the recent report serves as a reminder to providers of the importance that all hospices deliver patient- and family-centered care that meets the highest quality standards,” Edo Banach, president and CEO of the National Hospice and Palliative Care Organization (NHPCO) told Hospice News. “NHPCO recommends nurse aide supervision on every nursing visit as a best practice, which could improve compliance with the every 14 day requirement. All hospices must ensure that every single patient receives care within all regulatory and statutory limits, that quality is never a question, and patient and family safety is never compromised.”

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