Hospice Advocates Praise Anti-Fraud Efforts, Urge Caution

WASHINGTON—Several homecare, hospice and other organizations have praised the Centers for Medicare & Medicaid Services’ (CMS’) efforts to combat home health and hospice fraud—but are also urging officials to protect patients and access to care and insisting most providers are acting in good faith. 

The National Alliance for Care at Home (the Alliance), LeadingAge, LeadingAge California, and the California Association for Health Services at Home sent a letter March 25 to CMS Administrator Mehmet Oz praising the agency’s actions to “root out bad actors who are exploiting the (Medicare) program and harming patients and families,” the groups said in a release. At the same time, the associations emphasize the need for a carefully targeted federal response to protect current and prospective patients, and preserve access to care delivered by trustworthy providers.       

“Recent national media coverage and federal enforcement actions have rightly focused attention on a serious fraud crisis in the Medicare hospice and home health programs, concentrated overwhelmingly in Los Angeles County and the surrounding Southern California region,” the organizations wrote. “It is critical to underscore, however, that this crisis is the result of a subset of bad actors exploiting regulatory gaps, and not a failure of the hospice or home health models of care. The overwhelming majority of providers serve their communities with integrity.” 

The four groups represent more than 1,500 hospice and home health providers with over 10,000 locations serving millions of Medicare beneficiaries across the country, including tens of thousands of patients and families in California. “Our members have built their reputations and their organizations on a commitment to compassionate, high-quality care,” they said. 

“We commend CMS for its continued focus on rooting out fraud and preserving the integrity of the home health and hospice benefits,” said Jennifer Sheets, CEO of the Alliance. “As these critical efforts continue, we must consider the downstream effects on reputable providers and the people they care for. Heightened oversight and added administrative complexity may cause physicians and practitioners to think twice about making referrals, and families, already navigating difficult decisions, could feel increased hesitation if messaging around bad actors overshadows the broader reality of high-quality care.” 

The letter also asked CMS to ensure transparency and timely information, citing issues with at least one of the Mediare administrative contractors related to reviews.

The National Partnership for Healthcare and Hospice Innovation (NPHI) also sent a letter to Oz the same day requesting CMS implement a time-limited nationwide moratorium on new hospice provider enrollments as a way to halt fraud. NPHI emphasized that the fraud issue stems from a subset of providers exploiting gaps in oversight.

“This issue is deeply frustrating to the many high-quality, mission-driven hospice providers — especially nonprofit organizations — that have served their communities with compassion and integrity for decades,” NPHI CEO Tom Koutsoumpas said in a release. “We cannot allow the actions of a small number of bad actors to erode public trust or discourage families from seeking hospice care when they need it most.”

NPHI also recommended that CMS focus review efforts on hospices that discharge more than half of their patients before death and urged additional training for reviewers, along with several other measures. 

All of the groups said that the agency should be sure its efforts are focused and targeted moving forward. 

“Home health and hospice services are relied on by millions of older adults and families annually.  Ensuring program integrity is critical–and without question that requires uncovering, addressing and stopping fraudulent actions. At the same time, acknowledgement of and support for compliant providers is also needed,” said Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit and mission-driven providers of aging services. “Gross overgeneralizations about the home health and hospice sectors unnecessarily undermine trust and do a disservice to the vast majority of providers who deliver compassionate, compliant care each day. We urge CMS to take a strong and balanced approach to enforcement.”