Literature Review

Gentiva reaches $19.4 million False Claims Act Settlement Policy & Medicine; by Thomas Sullivan; 10/15/24 Gentiva – formerly known as Kindred at Home – reached a $19.4 million settlement with the United States, resolving allegations that it violated the False Claims Act by holding on to overpayments for hospice services provided to patients who were ineligible to receive hospice benefits under various federal health care programs. Kindred is made up of entities that were previously part of an enterprise that did business through various subsidiaries as Kindred at Home. Kindred provided health care services, including hospice services, using various business names during the time periods relevant to the settlement. The settlement resolves allegations brought by the United States and the State of Tennessee against certain Kindred entities alleging that from 2010 until February 2020, the entities knowingly submitted (or caused to be submitted) false claims for hospice services to hospice patients in Tennessee and other states who were ineligible for Medicare or Medicaid hospice benefit because they were not terminally ill. The settlement further resolved allegations that the defendants improperly concealed or otherwise avoided the obligation to repay the hospice claims at issue. The settlement also resolves allegations that SouthernCare New Beacon – a subsidiary – allegedly violated the Anti-Kickback Statute by willfully paying remuneration to a consulting physician to induce Medicare beneficiary hospice referrals.

Managing the hospice payment cap by balancing Length of Stay Hospice News; by Jim Parker; 10/15/24 Careful management of the hospice aggregate cap is key to providers’ sustainability as regulatory scrutiny continues to heat up. The cap is designed to prevent overuse of hospice, put controls on Medicare spending and foster greater access to care among patients. For Fiscal Year 2024, the U.S. Centers for Medicare & Medicaid Services set the cap at $33,394. In 2025, this will rise to $34,465. “While the cap is a beneficiary driven cap, meaning the reimbursement allowed per Medicare beneficiary, it is not assessed at the beneficiary level, but rather in the aggregate at the agency provider number level for all beneficiaries served by the agency in the cap,” Rochelle Salinas, vice president of operations for CommonSpirit Health at Home, said. “This allows for greater flexibility in providing care to those in need.” ... [Click on the title's link to continue reading.]

The daily balancing act of value-based cancer care The American Journal of Managed Care (AJMC); by Laura Joszt, MA; 10/14/24 In value-based care, there’s a daily balancing act to achieve quality outcomes, cost reduction, and patient care improvements, explained Stuart Staggs, vice president of transformation, quality, and shared services for The US Oncology Network (Network). At the Institute for Value-Based Medicine event, cohosted by The American Journal of Managed Care (AJMC) and Minnesota Oncology, Staggs kicked it off with what he called a “practical look at value-based care.” He highlighted 4 main areas: quality, improvement, adoption, and cost. ... The area of improvement that the Network wanted to focus on was advanced care planning and better supporting and engaging patients and their families around hospice and life support. During the OCM, the Network better engaged patients and families around hospice care and encouraged practices to have difficult conversations. Not only does this improve patient experience by providing them the end-of-life care that they want, but there is also a cost factor. Patients who don’t receive hospice care spend significantly more in the last 30 to 60 days, Staggs said.

Millions of aging Americans are facing dementia by themselves California Healthline; by Judith Graham; 10/15/24 Sociologist Elena Portacolone was taken aback. Many of the older adults in San Francisco she visited at home for a research project were confused when she came to the door. They’d forgotten the appointment or couldn’t remember speaking to her. It seemed clear they had some type of cognitive impairment. Yet they were living alone. Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing? ... Portacolone got to work and now leads the Living Alone With Cognitive Impairment Project at UCSF. The project estimates that that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States. ... Imagine what this means. ...

Home health providers, CMS raise red flags over delayed access Modern Healthcare; by Diane Eastabrook; 10/11/24 Delayed home health access for Medicare beneficiaries is increasingly raising alarms from the Centers for Medicare and Medicaid Services and the home health industry as providers place blame on staff shortages and the program's reimbursement rates. More than a third of Medicare fee-for-service beneficiaries referred to home health following hospitalizations did not receive services within seven days of discharge, according to an analysis of 2023 Medicare claims from healthcare analytics company CareJourney. The report echoes a similar study published by the Commonwealth Fund in July, as well as concerns CMS raised about access in its proposed 2025 home health pay rule. ... Years of low Medicare reimbursements are taking a toll on the home health companies trade groups represent, said William Dombi, president emeritus of the National Association of Home Care and Hospice, which is part of the National Alliance for Care at Home, and Cunningham.

Two Los Angeles-area residents arrested on indictment alleging scheme to fraudulently obtain and launder Medicare proceedsUnited States Attorney's Office - Central District of California; Press Release; 10/9/24 A Los Angeles woman and a San Fernando Valley man were arrested today on a 24-count federal grand jury indictment alleging a scheme to defraud Medicare out of more than $54 million via hospice and diagnostic testing services that were never provided and then laundered their illicit proceeds, including by buying millions of dollars’ worth of gold bars and coins. Sophia Shaklian, 36, of the Larchmont area of Los Angeles, and Alex Alexsanian, 47, of Burbank, were arrested early this morning. They are scheduled to be arraigned this afternoon in United States District Court in downtown Los Angeles. ... According to the indictment that a federal grand jury returned on October 2, Shaklian, often using aliases, managed and submitted claims for seven health care providers enrolled with Medicare and located in Los Angeles County. These businesses included a hospice company she owned – the Pasadena-based Chateau d’Lumina Hospice and Palliative Care – and several diagnostic testing companies: Saint Gorge Radiology in Sylmar; Hope Diagnostics in North Hollywood; Direct Imaging & Diagnostics and Lab One – both located in Hollywood; and Labtech and Lifescan Diagnostics in Claremont.

The best bets for palliative care reimbursement post-VBID Hospice News; by Jim Parker; 10/8/24 The hospice component of the value-based insurance design model (VBID) will sunset at the end of this year, but opportunities for payment through Medicare Advantage and other models remain. The hospice component is part of the larger VBID program, which will continue through 2030. The component was designed to test coverage of hospice through Medicare Advantage. It also contained elements intended to expand access to palliative care, for which reimbursement in general is scarce. Hospice News spoke with Dr. Bob Parker, chief clinical officer and chief compliance officer for the Texas-based hospice provider Kindful Health, about the opportunities in place for palliative care providers. [Click on the title's link for this interview.]

Hosparus Health ranked fourth in nation for overall quality The News-Enterprise; 10/5/24 Hosparus Health has been ranked fourth in the nation for Overall Quality among the 50 largest hospices, according to a study published in the American Journal of Hospice & Palliative Medicine. This ranking was determined based on key metrics: Consumer Assessment of Healthcare Providers and Systems caregiver survey scores, employee satisfaction ratings from Glassdoor and sentiment scores from Google reviews. David W. Cook, president and CEO of Hosparus Health, expressed his pride in the organization’s staff. “Your care, your compassion, it’s those on the front line of our care,” Cook said. “It’s thrilling to see the recognition of what you do here celebrated nationally.” Since 1978, Hosparus Health has been at the forefront of hospice and palliative care services, caring for thousands of patients across Kentucky and Indiana, the release said. Today, the nonprofit organization, which has offices in Elizabethtown, continues to provide expert care and holistic support to more than 14,000 patients and families annually, ensuring that each individual receives compassionate, high-quality care during life’s most challenging times.

BREAKING NEWS 10/1/2024, 12:30pm - Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements; Correction Federal Register - The Daily Journal of the United States Government; Centers for Medicare & Medicaid Services  (CMS), Department of Health and Human Services (HHS); 10/1/24 This document corrects technical and typographical errors in the final rule that appeared in the August 6, 2024 Federal Register titled “Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements”.I. Background: In FR Doc. 2024-16910 of August 6, 2024 (89 FR 64202), there were a number of technical and typographical errors that are identified and corrected in this correcting document. The provisions in this correction document are effective as if they had been included in the final rule that appeared in the August 6, 2024 Federal Register . Accordingly, the corrections are effective October 1, 2024.II. Summary of Errors: ...Given these errors, we are republishing the FY 2025 Hospice Wage Index file accordingly on the CMS website at: https://www.cms.gov/​medicare/​payment/​fee-for-service-providers/​hospice/​hospice-wage-index effective October 1, 2024.

BREAKING NEWS 10/1/2024, 12:30pm - Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements; Correction Federal Register - The Daily Journal of the United States Government; Centers for Medicare & Medicaid Services  (CMS), Department of Health and Human Services (HHS); 10/1/24 This document corrects technical and typographical errors in the final rule that appeared in the August 6, 2024 Federal Register titled “Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements”.I. Background: In FR Doc. 2024-16910 of August 6, 2024 (89 FR 64202), there were a number of technical and typographical errors that are identified and corrected in this correcting document. The provisions in this correction document are effective as if they had been included in the final rule that appeared in the August 6, 2024 Federal Register . Accordingly, the corrections are effective October 1, 2024.II. Summary of Errors: ...Given these errors, we are republishing the FY 2025 Hospice Wage Index file accordingly on the CMS website at: https://www.cms.gov/​medicare/​payment/​fee-for-service-providers/​hospice/​hospice-wage-index effective October 1, 2024.

Alliance sees Hospice CARE Act as opportunity to advance hospice benefit discussionNHCPO / National Alliance for Care at Home; Press Release; 9/26/24 The National Alliance for Care at Home (the Alliance), a new national organization formed by the integration of the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) recognizes the introduction of the Hospice Care Accountability, Reform, and Enforcement (CARE) Act, by Congressman Earl Blumenauer (OR-3).  The Alliance shares Rep. Blumenauer’s desire to update the Medicare hospice benefit to address the evolving needs of our country’s aging population while ensuring the sustainability and integrity of the hospice program. As a long-standing champion of hospice care, Rep. Blumenauer has consistently demonstrated a commitment to ensuring that hospice services remain accessible, compassionate, and of the highest quality for patients and their families. The Alliance appreciates Rep. Blumenauer’s commitment to involving a diverse group of stakeholders in developing this legislation and will continue to work closely with congressional leaders on the finer points of the proposed bill to ensure that the final legislation supports the needs of patients, families, and providers alike. 

Blumenauer proposes overhaul to Hospice Benefit: If enacted, the legislation would be the single most significant update to the hospice benefit and payment structure since its inception in 1982.U.S. Congressman Earl Blumenauer, Washington, DC; Press Release; 9/26/24Today, Congressman Earl Blumenauer (D-OR), a senior member of the Ways and Means Committee, introduced the Hospice Care Accountability, Reform and Enforcement Act (Hospice CARE Act) to modernize Medicare’s hospice benefit, which has remained largely unchanged since its inception in 1982. The proposal comes as egregious reportsof fraud and abuse within the benefit persist, despite action from Centers for Medicare & Medicaid Services (CMS). The legislation is the product of years of collaboration between stakeholders, lawmakers, and industry leaders. It builds on Blumenauer’s decades-long commitment to ensure the federal government supports families at a time of great stress and vulnerability: the end of life.