Current hospice requirements may be misaligned with the needs of today’s patients and their families, according to regulatory and legal experts. The issue has hospice providers grappling with compliance challenges. Established in 1983 through the Tax Equity and Fiscal Responsibility Act (TEFRA), the Medicare Hospice Benefit created a regulated reimbursement for interdisciplinary end-of-life care. Though […]
An advance care planning bill introduced in California has recently passed in the state Senate. Gov. Gavin Newsom (D) is now considering the legislation. If enacted, the legislation would introduce provisions to existing advance care planning options designed to improve access to goal-concordant care. Sen. Catherine Blakespear (D-38) introduced the bill. “This legislation puts patients […]
Lynn Galbraith, 60, pleaded guilty to one count of health care fraud, according to the U.S. Attorney’s Office for the Central District of California. The Anaheim, California, former co-owner of Azure Hospice Care admitted to submitting more than $2.2 million in fraudulent Medicare claims for hospice services for patients who were not terminally ill, federal […]
The U.S. Department of Justice (DOJ) Fraud Division has designated home health and hospice as among its top enforcement priorities. The agency plans to use innovative data analysis to target fraud schemes in these industries, according to a Thursday memorandum. The agency plans to further crack down on healthcare fraud by increasing the headcount of […]
Hospice payment suspensions by the U.S. Centers for Medicare and Medicaid Services (CMS) have hit vendors hard, including pharmacies and durable medical equipment (DME) companies. CMS earlier this year began suspending Medicare payments to hundreds of hospices allegedly due to suspected fraud. Providers received letters indicating that they were suspended for at least 180 days, […]
Regulators are narrowing focus around hospice patient eligibility. Hospices in the Midwest and South have recently survived the scrutiny in federal courts in a case that could have ripple effects on regulatory oversight. The U.S. Court of Appeals for the Sixth Circuit oversees four states of Kentucky, Michigan, Ohio and Tennessee. The Sixth Circuit ruled in favor of hospice providers in a recent case that raised questions related to eligibility […]
The newly created service and spending variation index (SSVI) scoring system could challenge hospices’ compliance capabilities. The new SSVI system was recently introduced in the U.S. Centers for Medicare & Medicaid Services’ (CMS) 2027 final hospice rule. The scoring system uses nine claims-based measures to evaluate different aspects of hospice utilization and non-hospice spending. The […]
Two Nevada-based hospices are facing fraud allegations. In one case, a provider’s billing privileges have been revoked for the next decade. Meanwhile, a hospice physician has been indicted for their alleged involvement in a fraud scheme that bilked millions of Medicare dollars. Hospice Physician Indicted in $95M Kickback Scheme A Nevada-based physician has been indicted […]
Structuring palliative care payment through the home health benefit is the wrong approach, according to some hospice leaders. The U.S Centers for Medicare & Medicaid Services (CMS) in its proposed 2027 home health rule included language specifying that Medicare would cover community-based palliative care through the Medicare home health benefit. “CMS believes the Medicare home […]
Hospice organizations are expressing “disappointment” following the release of the U.S. Centers for Medicare & Medicaid Services’ (CMS) hospice final rule for 2027. A chief sticking point was the 2.3% base rate increase, which was less than the 2.4% the agency originally proposed. Members of industry trade groups contend that this is an insufficient amount […]
