OIG collected more than $5.8 billion in recoveries for FY 2013, makes hospice recommendations

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OIG collected more than $5.8 billion in recoveries for FY 2013, makes hospice recommendations
OIG collected more than $5.8 billion in recoveries for FY 2013, makes hospice recommendations

The Department of Health and Human Services Office of the Inspector General netted nearly $6 billion in recoveries in fiscal year 2013, and had strong recommendations for the Centers for Medicare & Medicaid Services in the year ahead.

The OIG worked on nearly 1,000 criminal actions against individuals and healthcare organizations engaged in illegal activity, according to the OIG's Dec. 23 Semiannual Report. The office reported $850 million in audit receivables and about $5 billion in investigative receivables.

While the report highlighted successes, such as the case against a fake physical therapist who was the eighth person to be indicted in a $45 million Medicare scheme, and Wyeth Pharmaceuticals agreeing to pay $490 million to resolve charges of improperly marketing Rapamune, it also made recommendations, including on hospice practices.

“Our past and current research indicates that hospices are often out of compliance; a 2007 report found that almost half of hospices were cited with deficiencies when surveyed,” the report states. “More recent OIG reports identified quality-of-care concerns regarding hospice care provided in nursing homes.”

The OIG recommended that CMS set specific timeframes for the frequency of hospice recertification surveys. It also recommended that CMS change regulations to establish a “hospital transfer payment policy for early discharges to hospice care,” noting that if Medicare Part A had started a hospital transfer payment policy for early discharges in 2009 and 2010, it could have saved the government more than $600 million.

The report was issued the same week as a Washington Post investigative piece on hospice, specifically on how patients being discharged alive from hospice has jumped dramatically in the past decade. In a response, LeadingAge's Larry Minnix said the piece raises “some important questions about the incentives that Medicare hospice payments create and how some providers are potentially exploiting the benefit.”

However “we know that our members serve thousands of Medicare beneficiaries at the end of life with care, dignity and compassion," he said. 

The organization said it supports MedPAC recommendations that would decrease incentives for enrolling people for long periods of time while providing little care. It also supports the government paying more for the initial care and intensive care in the time right before death.

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