Hospice fraud in OIG crosshairs

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Hospice fraud is an enforcement priority for the HHS Office of Inspector General, according to the head of the office.

Inspector General Daniel Levinson told attendees at the Health Care Compliance Association's Compliance Institute this week that kickbacks between physicians and hospice providers are an “alarming” concern for the office, Bloomberg BNA reported.

The comments were in tandem with guidance released Monday by the OIG that clarified its exclusion criteria for federal healthcare programs. The OIG noted in 2013 that excluded people often work in nursing homes.

But the new report makes it clear the OIG evaluates fraud cases on a continuum and that resolution “is based on OIG's assessment of future risk” to federal healthcare programs.

Providers that pose harm to patients or financial loss to federal programs are considered high risk, as are attempts to stop an investigation or a refusal to enter into a corporate integrity agreement.

Conversely, the OIG weighs low risk when there is absence of “egregious harm,” and considers whether the government is resolving a fraud cause with a successor owner. Factors in those cases include whether the new owner purchased the company after the fraud, whether the company has an existing compliance program, and whether there's a lack of prior wrongdoing.

The guidance updates a 1997 statement on exclusions.