Six Month Update on Hospice Program Integrity Recommendations

For Immediate Release
July 25, 2023

(Alexandria, VA) – In January of this year, NHPCO and other national stakeholder organizations submitted program integrity recommendations to Centers for Medicare and Medicaid (CMS) Administrator Chiquita Brooks-LaSure regarding ongoing efforts to stop fraudulent hospice activity, focused but not limited to bad actors operating in Arizona, California, Nevada, and Texas. In the six months since, CMS and the Office of Inspector General (OIG) for Health and Human Services have acted on 17 of those recommendations. These program integrity efforts include:

1. 1. Revocation of Medicare enrollment: CMS has identified fraud schemes and increased its operational ability to revoke Medicare enrollment more quickly.
  2. Organizational Deactivation: CMS proposes to revoke Medicare certification if a provider has not billed any claims within six months.
  3. Increased site visits for hospices suspected of being non-operational: CMS has initiated a National Site Visit Project to visit every Medicare certified hospice in the country and revoke Medicare Certification for non-operational hospices.
  4. Put certain new hospices into “high risk” survey category: CMS proposes moving initially enrolling hospices and those submitting applications with new ownership into the “high” level of categorical screening.
  5. Prohibit individuals with convictions for certain crimes from serving as hospice administrators or owners: CMS proposes to require all hospice owners with five percent, or greater, direct or indirect ownership to submit fingerprints for a criminal background check allowing CMS to detect parties potentially posing a risk of fraud, waste, or abuse before it begins.
  6. Ownership disclosure: If the company is not publicly traded, require disclosure of ownership and control, major investors over a certain threshold: CMS proposes modifying the provider enrollment application to collect additional information, including new categories of organization types and organizational ownership.
  7. Drive-by surveys to confirm operations: As previously mentioned, CMS has implemented a National Site Visit Project to visit every Medicare certified hospice in the country.
  8. Require a hospice agency to have specified personnel categories on a CCN application or revalidation and require the hospice agency to provide certain information for individuals in these types of positions: CMS proposes to add hospice administrator and hospice medical director to the definition of “managing employee” which requires hospices to report these roles.
  9. Require new hospices to undergo more frequent surveys: CMS announced enhanced oversight for newly enrolling hospices and hospices submitting a change of ownership, in Arizona, California, Nevada, and Texas.
  10. Care Compare Website: CMS proposes to post data about hospices in the Hospice Special Focus Program at least annually on a CMS public-facing website, increasing hospice transparency.
  11. Require an onsite survey within one year when there is a change in ownership: CMS announced enhanced oversight for hospices submitting a change of ownership, in Arizona, California, Nevada, and Texas.
  12. Prohibit sale or transfer of hospice certification number for specified timeframe: CMS proposes prohibiting sale or transfer of certification within 36 months of certification or most recent ownership change.
  13. Ensure survey oversight for ability to provide all 4 levels of care, including General Inpatient Care (GIP) and respite contracts, as well as provision of continuous home care (CHC) and afterhours care: CMS published a Request for Information (RFI) on Hospice Utilization; Non-Hospice Spending; Ownership Transparency; and Hospice Election Decision-Making. Through this RFI, CMS requested feedback on barriers to higher intensity levels of care.
  14. Presence of corporate compliance plan: OIG announced it would be modernizing its Compliance Program Guidance (CPGs), including the industry-specific CPGs (ICPGs) by the end of 2023.
  15. Hospice Special Focus Program: CMS proposed moving forward with the Special Focus Program targeted at poor performing hospices identified through surveys and quality metrics.
  16. State Operations Manual – Appendix M Hospice Guidance for Surveyors: CMS revised Appendix M to include guidance for surveyor training, accrediting organizations in surveyor training, and protocols for surveyor conflict of interest.
  17. Background Checks (Require background checks on hospice agency owners/administrators): CMS proposed newly enrolled hospices requiring all owners with five percent direct and indirect ownership to submit a criminal background check, including fingerprinting.

This approach is core to NHPCO’s advocacy efforts. For high-quality hospice to continue to exist, hospice care needs to stay true to its core value. In protecting those values, the hospice national stakeholder groups must work together to weed out any bad actors and support the delivery of the highest quality of care.

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About NHPCO
The National Hospice and Palliative Care Organization (NHPCO) is the nation’s largest and oldest membership association for providers who care for people affected by serious and life-limiting illness. Our members deliver and expand access to high-quality, person-centered interdisciplinary care to millions of Americans. NHPCO provides education and resources to support that mission. Together with our advocacy partner, the Hospice Action Network (HAN), we serve as the leading voice advancing public policy to improve serious-illness and end-of-life care, while our CaringInfo program provides free resources to educate and empower patients and caregivers. nhpco.org

Press Contact
Madison Summers
NHPCO Communications
Ph: 571-412-3973