Eli's Hospice Insider

Published on Wed Jun 17, 2020 PDF

Aide supervision, drug coverage get mentions.

The HHS Office of Inspector General doesn’t include specific hospice fraud cases in its latest Semiannual Report To Congress, but that doesn’t mean hospice gets a pass.

The OIG reviews its November 2019 report, “Registered Nurses Did Not Always Visit Medicare Beneficiaries’

Homes at Least Once Every 14 Days To Assess the Quality of Care and Services Provided by Hospice Aides.”

Medicare hospice conditions of participation require RNs to conduct aide supervisory visits every 14 days, when aide services are ordered. RNs must document the visits in the clinical record, the Conditions of Participation say. Also, aides don’t need to be present during the supervisory visits.

The OIG audited about 189,000 “high-risk” RN visit date pairs in 2016 that were more than 14 days apart. Based on reviews of 78 claims from that pool, the OIG estimates that with 99,000 of the date-pairs (52.4 percent), RNs did not make supervisory visits as required. And with another 5,000 of the date-pairs (2.6 percent), RNs didn’t document the supervisory visits sufficiently (see more about the report in Hospice Insider, Vol. 13, No. 1).

CMS agreed with the OIG’s recommendations, including working with state survey agencies and accreditation organizations to increase emphasis on the requirement.

The report also briefly mentions the August 2019 report, “Medicare Part D Is Still Paying Millions for Drugs Already Paid for Under the Part A Hospice Benefit” (see Eli’s HCW, Vol. 12, No. 10).

Note: The report is at https://oig.hhs.gov/reports-and-publications/archives/semiannual/2020/2020-spring-sar.pdf.