Health Information Management

News: Hospices inappropriately billed Medicare over $250 million for general inpatient care

CDI Strategies, April 7, 2016

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Recent investigations by the Office of Inspector General (OIG) have shown a number of instances in which hospices inappropriately billed Medicare for hospice general inpatient care (GIP), according to a statement released by the OIG.

The OIG found that hospices billed one-third of GIP stays inappropriately, costing Medicare $268 million in 2012. Misuse of GIP includes care being billed but not provided and beneficiaries receiving care they do not need. In addition to inappropriate stays, the OIG found that Medicare sometimes paid twice for drugs because they were paid under Part D when they should have been provided by hospice and covered under the hospice daily payment rate. Further, hospices did not meet all care planning requirements for 85% of GIP stays and sometimes provided poor-quality care.
 
Hospices commonly billed for GIP when the beneficiary did not have uncontrolled pain or unmanaged symptoms. For example, a hospice billed for GIP for a beneficiary with a circulatory disease who had no unmanaged symptoms. This beneficiary could have been cared for at home, but the hospice billed Medicare for 46 consecutive days of GIP. The hospice was paid just over $31,000 for the stay, according to the OIG.
 
The goals of hospice are to help terminally ill beneficiaries with a life expectancy of six months or less to continue life with minimal disruptions and to support beneficiaries' families and other caregivers. The care is palliative, rather than curative. Hospices must establish an individualized plan of care for each beneficiary, says the OIG. GIP is the second most expensive level of hospice care and is intended to be short-term inpatient care for symptom management and pain control that cannot be handled in other settings. 



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