HHS OIG: CMS Paid $6.6B for Nonhospice Care

WASHINGTON, D.C. (February 22, 2022)—Medicare paid a total $6.6 billion to nonhospice providers for services provided to hospice beneficiaries between 2010 and 2019, according to a new report from the U.S. Department of Health & Human Services Office of the Inspector General (OIG).

Nonhospice payments are payments for items and services provided to beneficiaries outside the Medicare hospice benefit during a hospice period of care. Almost half of the 1.2 million to 1.6 million hospice beneficiaries each year received nonhospice items and services during a hospice period of care.

The majority of the $6.6 billion payments to nonhospice providers for hospice beneficiaries were for Medicare Part B items and services, OIG found. Nonhospice payments for Medicare Part A services decreased 45% while Part B increased 38% during the period studied. The number of claims billed to Part B increased 19% over the audit period.

Nonprofit providers received $2.5 billion (38%) of the nonhospice payments, compared to $4.1 billion (64%) going to for-profit providers. OIG noted that during the audit period, the number of for-profit hospice provider increased 78%, from 2,000 to 3,562. By 2019, for-profit providers made up more than two-thirds of hospice providers.

The agency examined Medicare claims data to determine these amounts, but stated that it did not independently verify the accuracy of the claims or conduct a medical review of whether services were related to the terminal diagnosis. OIG stated that the audit was done in accordance with generally accepted government standards.

In the report, the agency repeats earlier recommendations for stronger oversite on “unbundled” services. While the agency did not make any new recommendations, it did restate the recommended that the Centers for Medicare & Medicaid Services (CMS) study whether hospice payment reform is needed to address duplicate payments. 

CMS has long taken the position that any care or services a hospice patient needs should be covered under the hospice benefit, and payments outside the benefit should be “exceptional, unusual, and rare.”

Find the full report here.