Hospice Provider Experience Underscores Urgency of Program Integrity Efforts

WASHINTON and ALEXANDRIA, Virginia—Following a series of meetings with the Centers for Medicare & Medicaid Services (CMS) and Members of Congress on efforts to improve and protect hospice program integrity, four national hospice organizations—LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO) and the National Partnership for Healthcare and Hospice Innovation (NPHI)—released findings of a hospice provider survey that the organizations say underscores the urgency and need for CMS and Congress to act.

Previously shared with both CMS and Members of Congress, the survey findings provide policymakers with important on-the-ground examples of shortcomings in the current audit process. Areas of emphasis during these conversations included:

• The need for hospice audits to appropriately target bad actors and those with deficient quality indicators.
• A request for CMS to be more transparent regarding the outcomes of the audit adjudication process, including by making denial and appeals data available to providers and the public.
• Reemphasis on the importance of auditor training to ensure expertise on hospice specific issues, which are distinctly separate from those faced by hospitals or home health agencies.

“We’re moving in the right direction,” said Katie Smith Sloan, president and CEO, LeadingAge. “Not only have nearly half of the 34 recommendations presented in early 2023 to improve oversight of the benefit been implemented, CMS, in our recent conversations, has demonstrated a willingness to consider, holistically, which pieces of oversight need to be strengthened and which need to be redirected. These survey findings, which underscore what’s not working currently, are the next step in that work. To ensure hospice beneficiaries are served by high quality hospice providers, the current oversight system must be reformed and enforcement-focused to uncover genuine instances of fraud, waste, and abuse. We look forward to continuing our work  with CMS and Congress to ensure an equitable and effective enforcement system that preserves access to nonprofit, mission driven hospice care.”  

“We look forward to continued work with CMS to improve the audit process to ensure it is equitable and targets genuine instances of fraud, waste, and abuse that negatively impacts well-meaning providers, patients and the Medicare program,” said a release from NAHC. 

LeadingAge, NAHC, NHPCO, and NPHI continue to work closely with bipartisan congressional members to discuss potential legislative solutions including enhanced transparency.