Understand Hospice Audit Types, Processes to Boost Compliance

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 […]

New Charges Filed in $152 Million Merida Hospice Fraud Case

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 […]

Hospices Seek Engagement With Policymakers on Payment, Regulation

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 Physician Found Guilty in Hospice Fraud Scheme

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 […]

Hospices Hail CMS Pay Bump, Worry About Rising Costs

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 […]

Lax Regulation in California Led to Widespread Hospice Fraud

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 […]

CMS Proposes 2.7% Hospice Payment Raise for 2023

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 […]

MedPAC: Cut Hospice Payment Cap by 20%, Report Telehealth on Claims

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% […]

2 Arrested, 1 at Large in California for $30 Million Hospice Fraud Scheme

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 […]