How Emerging Hospice Regulations Could Impact Providers

Hospice News | By Holly Vossel

Increased hospice oversight aimed at curbing fraud in the industry could come with a mixed bag of financial and operational impacts for providers.

The U.S. Centers for Medicare & Medicaid Services (CMS) has honed in on hospice program integrity, rolling out a swath of new measures to reduce fraud, waste and abuse in the space. During the past two years, CMS has introduced new regulations, updated survey process, increased auditing activity and enhanced reviews of providers’ claims, patient eligibility and quality data.

Hospice regulation has taken a winding path in recent years, representing both a push and pull in terms of quality hospice care delivery, according to William Dombi, president of the National Association for Home Care & Hospice (NAHC).

“Hospice has come under increasing fire over recent years, initially from reports about hospices that perform poorly on health and safety standards and endanger vulnerable patients, and more recently with respect to dramatic growth in the number of hospice providers in some western states that have raised program integrity concerns,” Dombi said in a statement emailed to Hospice News. “All concerned have a part to play in addressing these concerns.”

Patient safety concerns came to the forefront in hospice in 2019 following a report from the U.S. Department of Health and Human Services Office of the Inspector General (OIG). The report rocked the industry when it found that roughly 20% of hospices surveyed by regulators or accreditors between 2012 and 2016 had a deficiency that posed a serious safety risk.

Meanwhile, a swathe of newly licensed providers emerged in Arizona, California, Nevada and Texas that have caught the attention of regulatory watchdogs. Evidence suggests that potentially hundreds of these hospices were established with the purpose of selling the license at a profit or committing fraudulent acts. In some instances, multiple hospices have been operating out of the same address without a corresponding increase in the population of eligible patients.

The proliferation of new hospices being “flipped” for profit prompted new regulations to address these concerns. CMS in its proposed home health rule for 2024 introduced a requirement that would prohibit hospice owners from selling their businesses within 36 months of Medicare enrollment to curb illegal or unethical activity.

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