OIG’s fraud and abuse concerns

Here are some of the special areas of OIG concern included in the draft compliance program for hospice:

• Uninformed consent to elect the Medicare hospice benefit.

• Discriminatory admission.

• Admitting patients to hospice who are not terminally ill.

• Arrangements with other providers that a hospice knows is submitting claims for services already covered by the Medicare benefit.

• Falsified medical records or plans of care.

• Untimely and/or forged physician certifications on plans of care.

• Inadequate or incomplete services rendered by the interdisciplinary group.

• Hospice incentives to actual or potential referral sources, such as physicians, nursing homes, hospitals, etc.

• Overlap in services that a nursing home provides which result in insufficient care provided by a hospice to a nursing home resident.

• Improper relinquishment of core services and professional management responsibilities to nursing homes, volunteers, and privately paid professionals.

• Providing hospice services in a nursing home before a written agreement has been finalized.

• Billing for higher level of services than necessary.

• Inadequate justification in the medical record when a patient revokes the Medicare hospice benefit.

• Billing for hospice care provided by unqualified or unlicensed clinical personnel.

• False dating of amendments to medical records.

• High pressure marketing of hospice care to ineligible beneficiaries.

• Improper solicitation activities, such as "patient charting."

• Inadequate management and oversight of subcontracted services, which result in improper billing.

• Sales commissions based on length of stay.