Yesterday, August 22, 2023, the Centers for Medicare & Medicaid Services (CMS) announced that almost 400 hospices are now under intensified scrutiny due to concerning findings about irregularities within the hospice sector.1 CMS has taken strong measures in the past few months to tackle widespread concerns about fraud and abuse, including unannounced visits to every Medicare-enrolled hospice across the country. As of mid-August, CMS completed more than 7,000 visits.
Emphasizing the spiritual, social, emotional, and physical role that hospice and palliative care providers serve in the lives of patients and families, CMS discussed the importance of protecting beneficiaries from what it sees as a growing trend of fraudulent activities, with Arizona, California, Nevada, and Texas named as states of particular concern. CMS also referenced the detrimental impact of media stories about hospices engaged in "churn and burn" billing schemes, undermining the program's integrity.
Given the magnitude of the problem, CMS is introducing a set of robust policies. The announcement included a variety of proposed regulatory changes and pilot projects, including the following highlights:
To expand on this summary of the case, see the original CMS post, paying particular attention to the changes coming soon. The following strongly worded statement from CMS captures the intensity of focus now being placed upon hospice organizations:
"CMS is committed to addressing benefit integrity and quality issues across our programs to protect Medicare beneficiaries and their families. We take our role as stewards of the Medicare Trust Funds seriously and work to ensure that taxpayer dollars are spent on high-quality, necessary care for each beneficiary. Part of this includes preventing fraud, waste, and abuse from taking place in the first place. CMS has adopted new policies and safeguards to quickly identify and take action against hospices engaged in such practices, ensuring they provide critical, quality care to some of our most vulnerable beneficiaries at the end of life."
Heather Thompson is Home Care Tech Report's staff AI expert. In addition to AI, Her focus areas are growth strategy and the Agency of the Future. Previously known as Heather Rooney, she started her career at OCS, a pioneer in benchmarking and business intelligence for Healthcare at Home. She later founded her own firm, Heather L. Rooney Strategy & Marketing. Heather has over 20 years of experience in home health, hospice, and private duty home care. She is a nationally recognized thought leader, keynote speaker, and respected voice in major publications. Heather has a solid reputation for helping organizations position themselves for dynamic shifts and emerging trends. She is also an award-winning artist, contemplative theologian, and disability/rare disease advocate published worldwide. Heather is excited to be back with the home care community during this unprecedented moment in technological history. Connect with Heather directly via her website,www.HeatherThompson.io.
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