Most hospice services in nursing homes fail to meet Medicare requirements, OIG finds

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Most hospice services in nursing homes fail to meet Medicare requirements, OIG finds
Most hospice services in nursing homes fail to meet Medicare requirements, OIG finds

A growing number of Medicare beneficiaries are receiving hospice care in nursing facilities. But most of these services do not meet Medicare requirements. That is according to two reports from the Office of the Inspector General of the Department of Health and Human Services.

The first report, "Medicare Hospice Care: Services Provided to Beneficiaries Residing in Nursing Facilities," finds that the number of beneficiaries receiving hospice care in nursing facilities has risen dramatically over the last few years. It has expanded from 580,000 in 2001 to 939,000 in 2006, an increase of 62%. Roughly 31% of Medicare hospice beneficiaries lived in a nursing facility during 2006, at a cost to the government of approximately $2.59 billion, or $960 per week per beneficiary, the report said. The most commonly provided hospice services included nursing services, home health aide services, and medical social services.

An accompanying report, "Medicare Hospice Care for Beneficiaries in Nursing Facilities: Compliance with Medicare Coverage Requirements," shows that 82% of these services provided in nursing facilities do not meet Medicare coverage requirements. When it came to election statements, plans of care, services, or certifications of terminal illness, the report says 81% of all claims did not meet even one of the requirements. A further 1% of claims were undocumented. These claims siphoned $1.8 billion from Medicare during 2006, according to the report.