Literature Review

CMS is taking action to address benefit integrity issues related to hospice care CMS Newsroom; by Dara A. Corrigan and Dora L. Hughes, MD, MPH; 8/22/24... Unfortunately, hospices are profiting from fraud at the expense of beneficiaries far too often. Recent media reporting, and research by CMS, have identified instances of hospices certifying patients for hospice care when they were not terminally ill and providing little to no services to patients. The media reports identified that these activities led to a rapid growth in potentially fraudulent hospices, particularly in Arizona, California, Nevada, and Texas. Some of the addresses listed for these hospices also appeared to be non-operational. ... In response to these findings, CMS revisited and revitalized our hospice program integrity strategy, focusing on identifying bad actors and addressing fraudulent activity to minimize impacts to beneficiaries in the Medicare program. As part of this strategy, CMS embarked on a nationwide hospice site visit project, making unannounced site visits to every Medicare-enrolled hospice. [Click here to continue reading this significant information from CMS.]

YoloCares: Overregulated California skips key regulations Our Community Now (OCN); by Craig Dresang, Special to The Enterprise; 8/17/24 California is the most heavily regulated state in the country. According to the Mercatus Center at George Mason University, the Golden State has 420,434 regulatory restrictions which is more than double the national average. ... So, it seems ironic that certain critically important sectors in California that impact the well-being, health and quality of life for millions of seniors are grossly unchecked and mis-regulated. My husband, who has owned and operated salons for nearly 30 years, pointed out that California’s Board of Barbering and Cosmetology (BBC) appears to have more rigorous rules and regulations for nail technicians than it does for board-and-care (B&C) owners or privately owned hospice companies. ... [Click on the title's link to continue reading.]

Humana will pay $90 million in Medicare drug fraud settlement Bloomberg Law; by Daniel Seiden; 8/16/24 Humana Inc. agreed to pay $90 million to the federal government to settle a whistleblower’s False Claims Act suit alleging that the company submitted fraudulent bids for Medicare Part D prescription drug contracts. Whistleblower Steven Scott alleged that, since 2011, Humana began offering its Medicare Part D prescription drug plan, known as the basic Walmart Plan, and “knowingly provided benefits under that plan that have been significantly less valuable than Humana promised in its bids,” according to Scott’s suit filed in 2016 in the US District Court for the Central District of California. ... This suit was among several in 2016, including suits against Humana, United Health, Cigna Corp., and Optum RX Inc., accusing health insurers of secretly overcharging for prescription drugs.

Stay ahead of Medicare fraudsters ... Watch out for Medicare fraudsters The Times of Noblesville, Indiana; Information provided by the U.S. Department of HEalth & Human Services 8/16/24 (Family Features) ... Watch Out for Medicare Hospice Fraud: Beware of scammers offering older Americans in-home perks, like free cooking, cleaning and home health services, while they are unknowingly being signed up for hospice services. The scammers then unlawfully bill Medicare for these services in your name. Remember this advice to avoid hospice scams: [practical tips for the public] ... Report Medicare Fraud ...Editor's Note: This information for the public--provided by the U.S. Department of Health & Human Services--provides an important resource for your community outreach, marketing, and admissions employees.

Staff education an anchor amid widespread hospice audits Hospice News; by Holly Vossel; 8/14/24 ... More than half of hospice providers reported having multiple types of audits within a six-month span in a survey earlier this year. ... Supplemental Medical Review Contractor (SMRC) and Targeted Probe and Educate (TPE) audits are among the most common types of audits that hospices undergo simultaneously alongside others. ... Staff need a firm understanding around the potential red flags on regulators’ radars and how to avoid common compliance errors in their roles, ... Compliance training should be focused on staff’s overall responsibilities alongside the larger bottom line of quality, she said. ... Notable mentions: Jason Bring, co-chair of post-acute and long-term care at the law firm Arnall Golden Gregory LLP (AGG)l; Megan Turby, vice president of quality and compliance at Gulfside Healthcare Services; Dr. Lisa Barker, chief medical officer at Gulfside Healthcare Services

Cost report prompts tweaks to ACO REACH model Modern Healthcare; by Bridget Early; 8/12/24 The Centers for Medicare and Medicaid Services is making changes to its largest accountable care organization experiment to ensure it’s actually saving money. In a notice published on its website Aug. 1, CMS outlines a slew of planned updates to the ACO Realizing Equity, Access and Community Health, or ACO REACH, model in 2025. Notably, the agency is changing how it establishes benchmarks for "high-needs population" ACOs to guard against overspending while addressing the so-called "ratcheting effect," under which ACOs that contain spending face higher hurdles to earning shared savings in future years because of their past successes. [Limited access due to paywall.]

Free CHAP Webinar: CMS Posts Final Hospice Rule - Quality changes and regulatory requirement Community Health Accreditation Partner (CHAP); taught by Dr. Jennifer Kennedy; posted 8/13/24, webinar will be 8/21/24, 1:00-2:00 pm EDTCMS posted the final rule for hospice providers which drives big changes into motion for 2025.  [Click here for the] Final FY 2025 Hospice Wage Index and Payment Rate Update/Quality Reporting Rule  (CMS-1810-F), posted on the Federal Register on August 7, 2024. This free webinar will be taught by Jennifer Kennedy, Vice President, Quality, Compliance and Standards, CHAP. She spent many years as a leader and nurse in diverse healthcare settings with the past 25 years in hospice and palliative care. Dr. Kennedy came to CHAP in 2021 with a vision of moving the organization’s quality forward as “the” accreditation partner of choice for the majority of community-based providers. She believes no matter what type of care a patient receives or how many times they receive care, every experience should be of the highest quality. Webinar Objectives:

CDC releases new profile of assisted living residents McKnights Long-Term Care News; by Kimberly Bonvissuto; 8/10/24 Residents living in assisted living and other residential care communities in 2022 mostly were female (67%), white (92%) and 85 or older (53%), according to a new report from the Centers for Disease Control and Prevention’s National Center for Health Statistics. The CDC said that data from the National Post-acute and Long-term Care Study outlined in the profile of residential care community residents in 2022 would help inform policymakers, providers, researchers and consumer advocates planning to help meet the needs of a rapidly growing older adult population. 

Are there bedbugs and busted equipment at your Florida hospital? What inspectors found Miami Herald; by Michelle Marchante; updated 8/12/24 Bed bugs. Broken equipment. Staffing challenges. Fewer patients. And a pile of hazardous waste. These are just some of the problems spotted by patient care ombudsmen during visits to Florida hospitals owned by Steward Health Care System and now up for sale. ... Key takeaways: 

Value-Based Insurance Design Model: Hospice Benefit ComponentCMS email; 8/9/24Calendar Year (CY) 2024 Technical and Operational Guidance on the Conclusion of the Hospice Benefit Component. The guidance covers CMS’s requirements and expectations for the remainder of the Hospice Benefit Component’s operations through Calendar Year (CY) 2024 along with requirements and expectations for operations on and after January 1, 2025. This document covers the following topics:

Enhabit walks away from UnitedHealthcare after ‘9 months of unsuccessful negotiations’Home Health Care News; by Joyce Famakinwa;8/7/24Staying on course with its payer innovation strategy, Enhabit Inc. (NYSE: EHAB) has decided to walk away from certain Medicare Advantage (MA) payers – and namely UnitedHealth Group’s (NYSE: UNH) UnitedHealthcare. That decision, and the recent home health proposed payment rule, were top of mind for Enhabit leaders on Tuesday.

Hospice advocate Judi Lund Person ... featured on Close Up Radio Western Slope Now, Ashburn, VA; by EIN Presswire; 7/26/24 (article) and 7/29/24 (recording)... Talking about where you’d like to be, who you’d like to be, and what you’d like to do is essential to entering this life-stage with confidence and grace. As the former Vice President of Regulatory and Compliance at the National Hospice and Palliative Care Organization (NHPCO) and a longtime advocate for hospice services under Medicare, Judi Lund Person has been working hard for more than 40 years to protect the definition of hospice care and to provide resources and guides for hospice providers to meet the Medicare requirements and provide high quality hospice care. ... Her passion for supporting patients and families during and after death began as a child. “When I was 12, my dad had a heart attack at night and passed when he was only 42. With two younger sisters, ages eight and ten, I was stunned that no one seemed to know what to do with us concerning our grief as children. We were left to try and figure it out on our own. I always thought that wasn’t quite right. Deep down, that experience was a driver for my career. I always knew families deserved more support during the grieving process,” shares Ms. Person. Editor's Note: Click here for the session's description. Click here for the recording. 

Home health sees spending, utilization decline as hospice equivalents grow, MedPAC reportsMcKnight's Home Care; by Adam Healy; 7/19/24Though hospice spending and utilization appear to be on the rise, Medicare spending on home health has fallen amid declining utilization in recent years, according to a new report by the Medicare Payment Advisory Commission. In 2022, the year of the most recent available data, Medicare home health spending shrank to $16.4 billion. That compares to $17 billion the year prior, the report found. Meanwhile, the number of home health users declined by 6.3% from 2021, and the overall share of Medicare beneficiaries that use home health shrank by 3% from the year prior. The total number of in-person home health visits decreased by 9.6% year-over-year in 2022... Meanwhile, the hospice industry has experienced both reimbursement and utilization gains in recent years, MedPAC reported. Medicare hospice payments rose 2.7% year-over-year in 2022, while the number of beneficiaries using hospice services ticked up by 0.4%. These patients are also receiving more care; the total number of hospice days provided to beneficiaries increased by 2% in 2022.