OIG Report Addresses Concerns Regarding Hospice Care Provided to Nursing Facility Residents

Medicare beneficiaries with a terminal illness may choose to receive palliative care instead of curative treatment under the Medicare hospice benefit. In recent years, the Office of Inspector General (“OIG”) has raised some concerns about the Medicare hospice care received by nursing facility residents. As a result, a number of OIG reports are anticipated to address these concerns.

The first report of the series, released in July 2010, describes the growth of hospice care from 2005 to 2009. Specifically, the report focuses on hospices which assisted a large portion of nursing facility residents in 2009.

The primary findings of the report state that:

• From 2005 to 2009, Medicare payments for hospice care provided to nursing facility residents have grown from $2.55 billion to $4.31 billion, a 69 percent increase.
• In 2009, 263 hospices (almost 8 percent of all hospices) had more than two-thirds of their beneficiaries in nursing facilities. Seventy-two percent of these hospices, referred to as high-percentage hospices, were for-profit. These high-percentage hospices “received more Medicare payments per beneficiary and served beneficiaries who spent more time in care.” Further, these “hospices typically enrolled beneficiaries whose diagnoses required less complex care and who already lived in nursing facilities.”

As a result of its findings, the OIG recommended that CMS “[m]onitor hospices that depend heavily on nursing facility residents” and “modify the payment system for hospice care in nursing facilities.” CMS concurred with the two OIG recommendations. The OIG recommendations result from a belief that some hospices may seek out Medicare beneficiaries with particular characteristics because certain conditions require longer but less complex care and could result in higher profits for those hospices.

The attorneys at THE HEALTH LAW PARTNERS can provide legal guidance to hospice organizations regarding a multitude of legal issues. For more information, please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510 or visit the HLP website.

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