Creator: Patrick Connole
CRS Report Pulls Lid off Hospice Fraud Actions by CMS
CRS has a new primer out called “Program Integrity in the Medicare Hospice Benefit,” which presents the full scope of CMS actions against alleged fraud in the space.
A recent Congressional Research Service (CRS) report called “Program Integrity in the Medicare Hospice Benefit” examines the reasons why the feds have been looking so closely at possible fraud in the hospice space.
The Medicare hospice benefit covers services designed to provide palliative care and management of a terminal illness for Medicare beneficiaries with a life expectancy of six months or less.
In 2023, approximately 1.8 million Medicare beneficiaries received hospice services. Through the Medicare benefit, hospice services must be provided through Medicare-certified hospice agencies. Over the past decade, the number of Medicare-certified hospice agencies has increased from 4,840 in 2019 to 6,706 in 2024, CRS said.
Broader Probe
The Centers for Medicare and Medicaid Services (CMS) has reported that certain states have had rapid growth in the number of Medicare-certified hospice agencies, and the agency has received reports of hospice fraud in these states.
“In response, CMS has taken actions to increase program oversight and engaged in enforcement activities, which has resulted in some hospice providers losing their Medicare participation status while raising questions about the potential effects on provider burden and beneficiary access to hospice services,” the report said.
Policymakers, CRS said, are often interested in Medicare hospice fraud because the issue intersects with other areas of federal policy, such as Medicare program integrity and the federal budget.
To assist Congress in its oversight of the Medicare program, CRS said its report briefly outlines the Medicare hospice benefit federal certification requirements and provides examples of hospice fraud. It then describes CMS's regulatory authorities to combat hospice fraud and details several of its actions to do so in recent years.
Finally, it concludes with selected considerations for Congress regarding Medicare hospice program integrity.
Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.
