Hospice Care in Nursing Facilities under the Medicare Hospice Benefit

The U.S. Office of Inspector General (OIG) has recently released this report, Medicare Hospice Care for Beneficiaries in Nursing Facilities: Compliance With Medicare Coverage Requirements.

The OIG report sought "to determine the extent to which hospice claims for beneficiaries in nursing facilities in 2006 met Medicare coverage requirements."

The report found:

Eighty-two percent of hospice claims for beneficiaries in nursing facilities did not meet at least one Medicare coverage requirement. Eighty-one percent of claims did not meet at least one Medicare coverage requirement pertaining to election statements, plans of care, services, or certifications of terminal illness. An additional 1 percent of claims were undocumented. Medicare paid approximately $1.8 billion for these claims.

Recommendations are given for improvement, including increasing education for hospices, making tools available to hospices, and increasing compliance monitoring.