Hospices have seen a spike in regulatory audits that could intensify as utilization rises. The U.S. Centers for Medicare & Medicaid Services (CMS), their contractors and the U.S. Department of Health & Human Services Office of the Inspector General (OIG) have been digging deeper into the hospice space in recent years, and many hospices are […]
Category: Regulation
Federal prosecutors have filed new charges in the U.S. District Court for the Southern District of Texas against Merida Group Owner Rodney Mesquais and CEO Henry McInnis. The criminal complaints allege that the two conspired to violate the False Claims Act by billing Medicare for medically unnecessary hospice care and home health services, totaling $152 […]
In an evolving payment and regulatory environment, hospices would benefit from stepping up their engagement with federal, state and local agencies and legislators. This may be particularly urgent now, with the public comment period still open on the 2023 proposed payment rule, and as policymakers debate whether COVID-related waivers and assistance should end. Federal agencies […]
Mississippi-based physician Scott Nelson, M.D., was recently found guilty of conspiracy to commit health care fraud. A federal jury convicted Nelson for his role in falsely referring and certifying patients to hospice who were not eligible to receive these services. Sentencing in the case is yet to be determined. Nelson from 2009 to 2014 served […]
The U.S. Centers for Medicare & Medicaid Services (CMS) recently proposed a 2.7% pay increase for hospice care for Fiscal Year 2023. While reimbursement increases are always welcome to providers, some stakeholders question whether this will be enough to fend off continuing COVID-19 headwinds and skyrocketing inflation. Also on providers’ minds is the phased-in return […]
Poor, uncoordinated hospice oversight by government agencies in California has contributed to widespread fraud and other violations, according to a report from the state’s Department of Justice (CDOJ). The report follows an audit of California’s agencies that oversee hospice providers, including the licensure process. The state’s legislature last October approved two bills requiring this audit […]
The U.S. Centers for Medicare & Medicaid Services (CMS) on Wednesday released the 2023 proposed payment rule for hospice providers, including a 2.7% per diem rate increase. The rule also contains a model for phasing in changes to the way CMS will use the wage index to inform payment rates in future years. Through the […]
Merida Group Owner Rodney Mesquais and CEO Henry McInnis have been found guilty of health care fraud upwards of $152 million, receiving prison sentences of 20 and 15 years, respectively. Texas-based Merida Group ran a network of home health and hospice centers in the state. Mesquais and McInnis were engaged in a scheme to falsely […]
Repeating similar calls in prior years, the Medicare Payment Advisory Commission (MedPAC) has recommended to Congress that Medicare hospice payment rates remain at current levels next year. The commission also called on the U.S. Centers for Medicare & Medicaid Services (CMS) to apply the wage index to the hospice aggregate cap, followed by a 20% […]
A $30 million hospice fraud scheme has unfolded in California with the arrest of a physician and a marketer. Both were associated with two Pasadena-based providers — Saint Mariam Hospice, Inc., and Arcadia Hospice Provider, Inc. — the owner of which remains at large for their involvement. Named in a 14-count indictment were physician Victor […]