The U.S. Office of the Inspector General (OIG) issued a report for greater oversight of non-hospice payments for items and services provided to beneficiaries outside the Medicare hospice benefit during hospice period of care for Medicare beneficiaries.
Analysis of trends and payment patterns indicate non-hospice payments for Medicare Part A and B items and services totaled $6.6 billion from 2010 through 2019. If providers bill Medicare for non-hospice items and services that potentially should be covered by hospices, Medicare could pay for the same items or services twice.
“If providers bill Medicare for non-hospice items and services that potentially should be covered by hospices, Medicare could pay for the same items or services twice.”
Four Key Trends
For calendar years 2010 through 2019, data analysis showed the following:
- The majority of $6.6 billion payments to non-hospice providers for hospice beneficiaries were for Medicare Part B items and services. Non-hospice payments are payments for items and services provided to beneficiaries outside the Medicare hospice benefit during a hospice period of care.
- Non-hospice payments for Medicare Part A services decreased 45 percent and for Part B items and services increased 38 percent.
- Almost half of the 1.2 to 1.6 million hospice beneficiaries each year received non-hospice items and services during a hospice period of care.
- The number of for-profit hospices relative to nonprofit hospices has grown significantly, and the majority of nonhospice payments were associated with for-profit hospices. A prior Office of Inspector General report identified areas of concern with for-profit hospices.
The information in this data brief may also help CMS determine whether the hospice benefit is operating consistent with its longstanding position that services unrelated to a hospice beneficiary’s terminal illness and related conditions should be exceptional, unusual, and rare given the comprehensive nature of the services covered under the Medicare hospice benefit.