Eli's Hospice Insider

Published on Thu Sep 15, 2022 PDF

The Senior Medicare Patrol’s recoveries are down, but it’s keeping up the pressure on the hospice industry.

Hospices have been feeling scrutiny from regulators for some time, but now it’s coming from a new source — your patients’ peers.

“In 2021, the 54 [Senior Medicare Patrol] projects had a total of 5,346 active team members who conducted a total of 12,660 group outreach and education events, reaching an estimated 556,980 people,” the HHS Office of Inspector General says in a new report, 2021 Performance Data for the Senior Medicare Patrol Projects (OEI-02-22- 00310). “In addition, the projects had 239,625 individual interactions with, or on behalf of, a Medicare beneficiary.”

The program integrity initiative saw a much lower return on investment in 2021 compared to the previous year. “For 2021, the SMP projects reported $2.5 million in expected Medicare recoveries,” vs. $16.8 million in 2020, the report indicates.

The SMP program did release a consumer fraud alert regarding hospice last year, however. “The alert warns beneficiaries about potential fraud schemes that involve unsolicited marketing tactics to enroll beneficiaries in hospice services. It advises beneficiaries to be sure that their doctor has assessed their condition and certified that they are terminally ill and expected to live 6 months or less,” the report says. “The alert also advises beneficiaries never to accept gifts in return for hospice services and to be wary of ‘too-good-to-be-true’ offers,” the OIG adds.

“The SMP projects conducted 304 group education events covering hospice fraud issues in 2021,” reaching a total of 11,795 people, the report says. “In addition, they conducted 101 instances of media outreach on this topic, reaching 17.3 million people.”

Since the program’s inception 25 years ago, expected recoveries to Medicare and Medicaid attributable to the projects have been $141.3 million, the OIG touts in the 81-page report at https://oig.hhs.gov/oei/reports/OEI-02-22-00310.pdf.