False Claims lawsuit, government report raise questions about expensive types of hospice care

Share this content:

A government lawsuit and a memorandum from the Department of Health and Human Services Office of Inspector General raise questions about the two most expensive types of hospice care.

The Department of Justice announced the False Claims Act suit against Chemed Corp. last week, alleging that Chemed and its subsidiaries were improperly paid tens of millions of dollars by Medicare. At issue are billings for crisis care. This type of care is associated with the highest daily hospice-related Medicare reimbursement rate, to cover treatment of acute medical symptoms. 

The lawsuit alleges that Chemed — described in the complaint as the nation's largest for-profit hospice chain — billed Medicare for unnecessary crisis care and set goals for how many crisis care days should be billed. Chemed responded by saying it has made "significant investments" to maintain regulatory compliance and ensure services are provided only to eligible beneficiaries. The company will "vigorously" defend itself. 

The OIG memo, released Monday, addresses a different aspect of hospice care: general inpatient care (GIP). This is short-term care for pain or symptoms that cannot be managed in a home setting, and requires an inpatient stay at a hospital, skilled nursing facility or hospice inpatient unit. It is associated with the second-highest Medicare hospice reimbursement rate.

The memo raises several concerns over GIP, including long lengths of stay in the inpatient setting, beneficiaries receiving GIP care unnecessarily, and billings for GIP care that was not actually provided. In 2011, one-third of GIP stays were longer than five days, according to OIG. The memo also refers to a recently settled lawsuit that involved claims of a hospice seeking reimbursement at the GIP rate for routine home care.

SNFs accounted for 8% of GIP stays in 2011, according to the memo.

The full document is available here.