Crossroads Hospice Sues HHS Over Recouped Payments

A Kansas City, Missouri, location of Crossroads Hospice has filed a federal lawsuit against U.S. Health and Human Services Secretary Xavier Becerra alleging that a Medicare contractor wrongfully sought to recoup payments.

The legal action follows a series of administrative appeals of the results of an audit of the hospice provider by the contractor. Crossroads disputes the contractor’s claim that documentation did not support a cohort of patients’ eligibility for hospice.

The company has also called into question the methodology that the contractor and an administrative law judge used to determine the dollar amounts to be repaid.

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“Crossroads argued that documentation in the beneficiaries’ medical records supports a finding that each beneficiary qualified for hospice care based on the clinical judgment of the treating physician and otherwise met the applicable hospice coverage requirements,” court documents indicated. “Crossroads also argued that AdvanceMed’s statistical sampling and extrapolation did not comply with CMS requirements, including, but not limited to, that the sample size was too small, not statistically representative of the patient population, and yielded an unacceptably high degree of imprecision.”

The Medicare claims in question date from Nov. 1, 2008 through Oct. 31, 2010. The contractor’s audit initially determined that documentation for 20 patients did not support eligibility or other services the patients received. Crossroads was told to repay Medicare more than $9.1 million. After a series of appeals by Crossroads, this was reduced to nine claims with a repayment in excess of $4.6 million.

Federal lawsuits are a last resort for hospices that dispute repayment orders from Medicare contractors following failed appeals and administrative adjudication.

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Crossroads has asked the court to reverse the administrative law judge’s decision for each of the nine beneficiaries; invalidate the contractor’s extrapolation and direct HHS to refund all recouped amounts including interest.

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