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Last week, the Office of Inspector General (“OIG”) published a report[1] of its study on the growth in hospice utilization and reimbursement since 2005.  The Report summarizes key vulnerabilities in the Medicare hospice program affecting quality of care and program integrity, and presents recommendations to the Department of Health and Human Services for protecting beneficiaries and improving the program.

Medicare’s hospice benefit covers care designed for the palliation and management of terminal illness. The care should “allow the patient to remain at home as long as possible by providing support to the patient and family, and by keeping the patient as comfortable as possible while maintaining his or her dignity and quality of life.”[2]

OIG found that hospices do not always provide sufficient services or medications to effectively manage patients’ symptoms, resulting in unnecessary pain.  Hospices also do not always provide families and caregivers with information needed to make decisions about a patient’s care. The Report highlights inappropriate hospice billing practices, including enrolling ineligible beneficiaries, and billing for services never provided or for a more expensive level of care than needed. In addition, OIG found that the current payment system creates incentives for hospices to minimize services and cherry-pick beneficiaries who have fewer or less complex care needs.

OIG’s findings confirm what the Center for Medicare Advocacy regularly hears from beneficiaries and their caregivers about their experience with hospice.[3]  We urge the Department of Health and Human Services to address the concerns identified by the Report, take steps to tie payment to quality of care, and help ensure that all terminally-ill beneficiaries have access to hospice services.


August 9, 2018 – W. Kwok

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