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OIG Finds Billing Vulnerabilities with Medicare Hospice Benefits

On September 22, 2010, the Office of Inspector General (“OIG”) released its Memorandum Report: Questionable Billing for Physician Services for Hospice Beneficiaries addressing a hospice billing vulnerability that cost CMS $566,000 in 2009. The OIG noted that there are instances of billing a single service under both Medicare Parts A and B. Specifically, “physicians may be billing for services related to the terminal illness under Part B that hospices are also billing for under Part A.” 11% of such practices are from Florida, the state with the most instances of duplicate billing, followed by North Carolina with 3%.

Typically, if the beneficiary’s physician is an employee or under contract with the hospice, Medicare pays the hospice for the physician’s services under Part A (and the hospice, then, compensates the physician). If, on the other hand, the beneficiary’s physician is not an employee or under contract with a hospice, then Medicare pays the physician, directly, under Part B. Under the OIG’s examination, it “identified instances in which a physician billed Part B for services provided to a hospice beneficiary for his or her terminal illness while a hospice billed Part A for services by that same physician for the same beneficiary and illness.” The OIG admitted that, through its evaluation, it could not discern whether or not the inappropriate billing was a fault on a physician’s part or a hospice’s part, and the OIG acknowledged that the problem did not appear to be widespread. Regardless, the OIG encouraged CMS to monitor the issue and work to correct the vulnerability.

For more information, please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510 or (212) 734-0128 or visit the Hospice specialty page on the HLP website.

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