Medicare Claims for Unrelated Services Put Hospices at Risk

August 18, 2022

Payouts for non-hospice services provided to Medicare beneficiaries has been in the billions. Investigators have urged regulators to ramp up oversight of potentially inappropriate billing practices. Hospices usually is not the one billing these inappropriate charges, it affects them anyway.

As a result, hospices can expect to see more auditing and scrutiny of what costs are deemed “unrelated” to end-of-life care, according to Judi Lund Person, vice president of regulatory and compliance for the National Hospice and Palliative Care Organization.

“We are seeing increased scrutiny of Medicare spending outside the benefit in Parts A, B, or D after a patient has elected their Medicare Hospice Benefit,” Lund Person told Hospice News in an email. “Additional scrutiny about these expenditures is on the rise, and providers should expect to see questions from the [Medicare Administrative Contractors (MACs)] and other auditors about why some items were considered to be unrelated. There will always be gray areas with relatedness based on diagnoses and treatments specific to an individual patient.”

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