OIG: Hospices need to better certify terminally ill patients to avert fraud

Hospice providers need to ensure their physicians have properly certified that a Medicare beneficiary is appropriate for hospice care, federal officials urged in a report released Thursday.

Physicians did not meet the requirements of certifying a beneficiary as eligible for hospice care in 14% of inpatient hospice stays analyzed, according to research by the Department of Health and Human Services' Office of Inspector General. Those requirements include fully explaining the clinical findings that helped determine that a beneficiary has six months or less to live — not solely writing, as one physician cited in the report did, “resp. failure dying.”

Many physicians also appeared to have limited involvement in the actual process of determining whether a beneficiary was appropriate for hospice care, the OIG said.

“It is essential that physicians fulfill their role and complete certifications as required, as these certifications are a critical safeguard in ensuring that beneficiaries are appropriately receiving hospice care,” the report reads.

The OIG's deeper look into hospice protocol was spurred by previous work by the agency that raised concerns about physicians' involvement in care planning, as well as previous cases in which hospices submitted fraudulent claims for patients who were not appropriate for hospice care.

The report also concluded that hospice providers need to improve the election statements signed by beneficiaries before they enter hospice, as one-third of these statements were found to be misleading and lacking in the required information.

The report recommends that CMS develop model text for hospice election statements. Report authors also want CMS to instruct surveyors to strengthen their review of beneficiary certification of terminal illness and educate hospices about such certifications.