Expanded Hospice Oversight

The U.S. Centers for Medicare & Medicaid Services (CMS) will expand its enhanced oversight for new hospices in California, Nevada, Arizona, and Texas to combat fraud, waste, and abuse. This includes prepayment medical reviews of claims before payment by Medicare Administrative Contractors (MACs). Initial review volumes will be low and adjusted based on compliance, but noncompliant hospices may face penalties such as claims denials or expulsion from Medicare. This oversight, which can last from 30 days to a year, applies to new hospices and those undergoing ownership changes. Non-responsive hospices may also see claims denied or their Medicare certification revoked. This initiative follows reports of unethical practices among new hospices, including fraudulent enrollment of ineligible patients and poor-quality care. CMS and the State of California have already implemented new regulations to address these issues. Additional information can be found HERE.