CMS Expands Hospice Oversight to Georgia, Ohio

WASHINGTON—The Centers for Medicare & Medicaid Services announced it is expanding the provisional period of enhanced oversight (PPEO) for newly enrolled hospices in Ohio and Georgia. This expansion adds to the list of states that have implemented the PPEO including Arizona, California, Nevada and Texas.

The PPEO can last from 30 days to one year and will include medical review of hospice claims, such as prepayment review.  CMS cited increases in reports of hospice fraud, waste and abuse, as well as rapid growth in hospice enrollment in the applicable states, as the basis for its expansion to Georgia and Ohio.

The enhanced oversight applies to all new providers who receive public funds, as well as those who have received approval for a change in ownership. CMS said those placed in a period of enhanced oversight will receive a letter that includes your effective date for the enhanced oversight period, the duration of the enhanced oversight period and a notice that CMS may do a medical review of all issued claims. CMS also noted that failure to respond to its requests could lead in denied claims as well as revocation of Medicare enrollment. 

New hospices that will be subject to CMS’s PPEO include:

• newly enrolling in Medicare;
• submitting a change of ownership as defined under 42 CFR 489.18;
• undergoing 100% ownership changes (including those not covered under 42 CFR 489.18); or
  reactivating after a deactivation.

CMS said officials may be affected if individuals have experienced the following: 

• Got final approval for Medicare enrollment on or after July 13, 2023
• Started the enrollment or certification process before July 13, 2023, but haven’t received a final
  approval letter from your Medicare Administrative Contractor
• Got approval on a change of ownership request on or after July 13, 2023

CMS said questions for further information can be sent to [email protected].