The Office of the Inspector General for the U.S. Department of Health and Human Services (OIG) provided results of a recent investigation into hospices which focused on inappropriate billing for hospice general inpatient care (GIP).
OIG performed a medical record review on a stratified random sampled of all GIP stays in 2012. They then estimated the percentage of GIP stays that were billed inappropriately.
The specific definition of “appropriate” was not provided in their report, although they noted that “GIP is the second most expensive level of hospice care and is intended to be short-term inpatient care for symptom management and pain control that cannot be handled in other settings.”
OIG found that 31 percent of the $1.022 billion spent on Medicare hospice care was inappropriate, or about $268 million. OIG also found:
Some states had significantly higher inappropriate GIP stays (the report singled out Florida).
For-profit hospices were more likely than other hospices to inappropriately bill for GIP. Hospice care provided in skilled nursing facilities than GIP were more likely to inappropriately bill for GIP.
Medicare sometimes paid twice for drugs because they were paid for under Part D when they should have been provided by the hospice and covered under the hospice daily payment rate.
Hospices did not meet all care planning requirements for 85 percent of GIP stays and sometimes provided poor-quality care.
“The findings in this report make clear the need to address the misuse of GIP and hold hospices accountable when they bill inappropriately or provide poor-quality care,” OIG said.