Eli's Hospice Insider

Published on Tue Jan 25, 2011 PDF

Watchdog agency is on the lookout for double payment for end-of-life services.

In its latest Semiannual Report to Congress, which covers HHS Office of Inspector General activity for fiscal year 2010, the OIG spotlighted a problematic trend rising out of hospices across the nation -- double payment for physicians' services.

The OIG examined "questionable billing" from physicians for hospice patients where the physician billed Part B for services that appeared related to the terminal illness. However, Medicare also paid for those services under Part A -- to the tune of an extra $566,000, according to a recent release.

Often the billing came from independent physicians, but 664 hospices were "associated with Part B questionable claims," the OIG notes. Of the 10 hospices with the highest questionable billing, eight were in Florida, the report points out.

However, the report wasn't total doom and gloom. "Along with our significant work related to a variety of HHS agency programs during this reporting period, we are particularly encouraged by the success of our partnerships with HHS and the Department of Justice through the Health Care Fraud Prevention and Enforcement Action Team (HEAT)," Inspector General Daniel R. Levinson stated in the release.

The OIG highlighted these other home care trouble areas in its report:

Payment errors. Both HHAs and DME suppliers made the list of top six provider types that saw the highest payment error rates in the latest Comprehensive Error Rate Testing report, the OIG notes. "Insufficient documentation, miscoded claims, and medically unnecessary services and supplies accounted for about 98 percent of the improper payments," according to the report.

DME. The OIG examined a number of DME issues in the last six months, including use of the KX modifier and capped rentals.

Final word: Investigators and other authorities are intent on clearing up questions and enforcing health care rules. For instance, the OIG's HEAT Strike Force teams yielded 89 convictions and $71.3 million in investigative receivables in the second half of FY 2010 alone, Levinson pointed out.

Resource: The complete OIG report is online at http://oig.hhs.gov/publications/sar/2010/fall2010_semiannual.pdf.