On the matter of hospice program integrity, policymakers have many questions and few answers.
U.S. Health and Human Services Secretary Xavier Becerra appeared yesterday on Capitol Hill for a hearing on President Biden’s proposed federal budget, during which several Congress members raised the issue of hospice fraud.
The key issue in these discussions is a proliferation of newly licensed hospice operators in multiple states, some of which have been associated with suspicious or unethical practices.
“More fraudulent hospice providers are gaming the system. They’re stealing Medicare dollars, assessing opioid medication and depriving patients of access to the care that they need,” Rep. Beth Van Duyne (R-Texas) said during the hearing. “We’re well beyond the time to be patient and the time for action is now. Families deserve more than from this administration. We have a bipartisan group of lawmakers, including my colleague from Oregon, [Rep. Earl Blumenauer (D-Ore.)] in the ready to address this issue.”
Van Duyne and Blumenauer in February wrote to Chiquita Brooks-LaSure, administrator of the U.S Centers for Medicare & Medicaid Services (CMS), requesting a briefing on the agency’s efforts to combat fraud. This followed a similar request from Senate members late last year. Both requests came with bipartisan support.
The troubling appearance of new hospices with questionable practices first arose in California during 2021.
In the hearing, Van Duyne pressed the HHS secretary for more clarity on the scope and nature of the problem and posed questions about possible penalties or other corrective actions.
While Becerra pledged in the hearing to provide those answers, he offered few specifics in the moment.
“Congresswoman, I’m surprised you didn’t get the answer that you wanted from CMS, and we can actually follow up if you’d like,” Becerra responded to Van Duyne. “But they’re not sitting around. We’re acting aggressively. In fact, in this budget, we’re asking for money to do exactly that, to go after the fraud and the abuse that’s going on.”
The White House’s proposed budget includes an outlay of $5.2 billion to support Medicare program integrity.
Blumenauer questioned the secretary on how the agency would use those funds to respond or prevent fraud.
“We want to make sure we get to go in and do some oversight. We want to make sure sunshine will be a good disinfectant when it comes to caring for our loved ones,” Becerra said. “And so we hope you will truly consider our request for more money so we can do the oversight.”
Despite the few details that emerged in this hearing, hospices can likely expect greater oversight on both the state and federal levels for the remainder of 2023 into 2024 and beyond.
For instance, CMS revamped its survey process for 2023, including new requirements for surveyor training and assessment tools and conflict-of-interest protocols.
While thus far California is the only state to take legislative and regulatory action against the licensing of potentially fraudulent hospices, other states are eyeing those policies.
A range of hospice providers have indicated support for government actions to address the growing problem.
“I think what California is doing with their latest regulatory changes, is not a bad thing. If you look at the growth in hospice in Texas, California and Arizona, it’s like 35% come from those states,” Traditions Health CEO David Klementz told Hospice News. “We need to make sure people are getting the space who want to professionalize it, provide high quality care and not just want to grow a business to flip a business.”
The HHS Office of the Inspector General will also be active this year, starting with a planned national audit on hospice eligibility.
Though to date, several previous OIG recommendations related to hospice program integrity have not yet been implemented, some going back several years.
“The Consolidated Appropriations Act of 2021 included a number of changes to improve hospice care. While the Act addressed several of OIG’s long-standing hospice recommendations, more needs to be done,” OIG indicated in a report. “Many of the changes required by the Act are not yet in practice, and there are still many OIG recommendations that have not been implemented. These include changing the payment structure, increasing oversight by improving the survey process and using available data to target oversight most effectively.”
In an interview with Hospice News earlier this month, Congresswoman Van Duyne said that hospice providers must have a seat at the table as potential solutions are designed.
“I haven’t ruled anything out at this point. We are trying to get as much data as we possibly can, trying to hear as many opinions as we possibly can,” Van Duyne told Hospice News. “But I want to make sure primarily that the caregivers’ hands are not tied. We’ve been working with a number of stakeholders and committee members to ensure that everything at this point remains on the table to be thoughtfully discussed.”