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A California hospice owner and a freelance marketer have been convicted of Medicare fraud, totalling $3.2 Nita Palma of Glendale, California, in 2025 purchased Magnolia Gardens Hospice through her daughter and concealed her ownership from Medicare, according to the U.S. million in claims for purported hospicecare.
Examining the future of dementia end-of-life care The findings demonstrate how the different approaches to dementia care can lead to comparable clinical outcomes, Reuben indicated. The study also includes examination of patients documented goals of care.
Terminally ill patients often lack a firm understanding and awareness about their end-of-life care options, a trend researchers across the world are examining more closely. million Medicare decedents who died in 2018 and examined the differences in hospice utilization during the last year and a half of life.
Medicare fee-for-service programs made $31.23 billion in improper payments during 2023, though a smaller proportion of those dollars went to hospices than in years prior. Hospices received nearly 5.4% of improper payments from Medicare in 2023, down from 12% in 2022, according to a new report from the U.S.
Cancer has been one of the most common conditions among patients since the MedicareHospice Benefit was established roughly 40 years ago. Alongside these have come regulatory changes and clinical capacity constraints, creating a difficult landscape for interdisciplinary hospicecare teams, Mayo stated.
The use of AI, for instance, has helped to reduce documentation redundancies and allow clinical teams to spend more time at the bedside a move improving both staff satisfaction and patient capacity. Centers for Medicare & Medicaid Services (CMS). Were in a better place going into 2025. Nine other de novos are also on the horizon.
The forthcoming HospiceCare Accountability, Reform and Enforcement (HospiceCARE) Act from U.S. Blumenauer announced the bill in June at the Hospice News Elevate conference in Washington D.C. Hospice News photo by Merz Photography. Oftentimes, they live longer,” Blumenauer said at Elevate.
This discussion took place on September 7, 2023 during the Hospice News ELEVATE Conference. Hospice News: Today we will talk about threads of clinical documentation and satisfaction and also revenue protection. Let’s just dig into what the problem is with that renewed focus on quality in hospice. They love doing it.
Documentation errors and a fragmented health system pose the greatest risks for adverse drug events among hospices. Identification of risk factors for ADRs may prevent occurrences in the complex palliative care patient.” Hospice providers have been closely evaluating how they prescribe and deprescribe medications for patients.
Hospice providers and stakeholders are carefully examining the proposed changes included in the recently introduced HospiceCare Accountability, Reform, and Enforcement (HospiceCARE) Act as the bill begins its journey through the legislative process. this summer. “It
Its making sure that documentation aligns and avoiding what can be a traumatic experience for people at the lowest points of life. Palliative care services often include goals-of-care conversations with patients and their families and assistance connecting them with advance directive resources.
The data come at a time when hospices are striving to better understand how to improve those groups’ end-of-life trajectories. Technology utilization has gained momentum in health care, including in hospicecare delivery. Coupled with the telehealth disparities are inequities pertaining to hospicecare.
Hospicecare has historically been grounded in person-to-person communication without a heavy reliance on technology. However, drastically increased hospice utilization and the pandemic-driven adoption of technology across health care settings have transformed the landscape entirely.
Centers for Medicare & Medicaid Services’ (CMS) proposed 2025 hospice rule contains clarifications on which physicians may certify patients for hospice enrollment. However, federal regulations are inconsistent as to which physicians can certify a patient as being terminally ill under Medicare.”
Though hospices are required to offer all four levels of care, more than half did not provide a single day of GIP during 2022, according to the U.S. Centers for Medicare & Medicaid Services (CMS). of hospicecare days in 2013, CMS reported. Utilization overall has been declining. GIP represented 1.8%
One of the defining principles of hospicecare is honoring the wishes of terminally ill patients. Now, with increasing frequency, a health care provider’s failure to honor those directives can lead to litigation or penalties by regulators. This can prevent or delay hospicecare for individuals who chose to receive it. .
Hospices that fail to shed a brighter light on their quality outcomes and staff training could avoid being left in the dark about their future compliance risks as new standards take shape in the forthcoming Hospice Outcomes and Patient Evaluation Tool (HOPE) tool.
Centers for Medicare & Medicaid Services (CMS) has unveiled its final 2025 hospice rule, which includes a 2.9% The increase represents an estimated $790 million rise in total hospice payments compared to Fiscal Year (FY) 2024. increase in per diem payments alongside new quality reporting measures.
Centers for Medicare & Medicaid Services (CMS) is conducting a small pilot program for post-payment reviews of hospice stays that exceed 90 days. CMS internal data has identified a potential area of vulnerability beginning with the second benefit period, or 91st day in hospice,” Noridian indicated in an announcement.
Centers for Medicare & Medicaid Services (CMS) has released its first draft guidance manual for implementing the Hospice Outcomes and Patient Evaluation (HOPE) tool. The tool is slated for an October 2025 implementation, according to the agency’s 2025 final hospice rule. The document contains introductory material.
While most agencies will never encounter a Targeted Probe and Educate (TPE) audit under the Centers for Medicare and Medicaid Services (CMS), prudent hospicecare providers will understand the purpose and process of the TPE program in order to best prepare should they encounter an audit in the near or long term.
Fraudsters have bilked Medicare for millions, with some cases resulting in criminal charges and even imprisonment. Navigating compliance Calls are growing louder for increased hospice program integrity oversight. The fraudulent activity has involved the enrollment of ineligible patients, often without their knowledge or consent.
Centers for Medicare & Medicaid Services (CMS) contracts UPICs to investigate instances of suspected fraud, waste and abuse. Percolating to the top is greater attention to hospicecare delivered to patients in skilled nursing facilities, Pekarske stated. We’ve found flaws in how they assemble the [claims] universe.”
It would have prohibited the establishment of for-profit hospices in New York state and forbid current for-profit operators from increasing capacity. . Data suggest that hospicecare is underutilized in New York compared to other states, straining other elements of the health care system,” Hochul wrote in her veto.
Centers for Medicare & Medicaid Services’ (CMS) 2025 proposed hospice rule contained requests for information (RFIs) that could signal changes in the agency’s thinking on key issues. Through RFIs, CMS tries to take the pulse of providers’ positions on certain questions that could impact the MedicareHospice Benefit.
The mechanics vary but the end result is the same: hospices getting paid for services they either did not provide, provided at a substandard level or had no authority to provide at all. This can be a challenge, especially when it comes to documentation. To fix that, hospices have to go deeper.
Hospice News spoke with c-suite executives who have recently stepped into their roles to learn more about what led them to the space and their top priorities. Regulatory challenges are among hospice leaders’ most significant concerns. We’re seeing a fair bit of variability in how different agencies approach documentation audits.
Utilization continuous home care has dropped precipitously during the past decade, with labor pressures, regulatory scrutiny and billing challenges as contributing factors. Continuous home care (CHC) represented 0.9% of hospicecare days during 2022, according to the National Hospice and Palliative Care Organization (NHPCO).
California is among the states that have become hotbeds for fraud, including a swath of providers that were starting hospices just to flip the licenses. Centers for Medicare & Medicaid Services (CMS) honed in on hospice program integrity through a number of new regulations, including some in the agency’s 2024 hospice final rule.
Department of Justice (DOJ) is pursuing a qui tam lawsuit against Care Alternatives Inc., Four former employees of Care Alternatives have alleged that the New Jersey-based company billed Medicare for hospice services when patients were not eligible to receive them. The lawsuit was filed in the third circuit U.S.
As federal regulators intensify their focus on hospices, operators may begin seeing an influx of Recovery Audit Contractor (RAC) activity. Centers for Medicare & Medicaid Services (CMS) contracts with RACs to conduct post-payment reviews designed to recover any funds that may have been overspent.
Caris Healthcare provides adult and pediatric hospicecare to more than 40,000 patients and families across 28 locations in Georgia, Missouri, South Carolina, Tennessee and Virginia. Additional services include palliative care, a veterans program and care coordination. On Wednesday, the U.S.
OIG alleged in a recent report that Summit Hospice violated the False Claims Act (FCA) by submitting claims to Medicare and Medicaid for non-covered hospice services. 1, 2018, Summit Hospice billed both Medicare and Medicaid for hospice services that were not medically necessary to patients who were not terminally ill.
Increased hospice oversight aimed at curbing fraud in the industry could come with a mixed bag of financial and operational impacts for providers. Centers for Medicare & Medicaid Services (CMS) has honed in on hospice program integrity, rolling out a swath of new measures to reduce fraud, waste and abuse in the space.
“For a hospice administrator or executive, you really have to be very focused on your length of stay data,” Young told Hospice News in a recent Elevate podcast episode. Are you in an outlier scenario with your data that Medicare contractors are looking at? Centers for Medicare & Medicaid Services (CMS) and the U.S.
She lost her appetite, isolated herself and stopped sleeping because she feared she would never wake up, court document s show. Roughly 70% to 85% of Merida’s patients were ineligible for the hospicecare they received, according to prosecutors. Of that amount, Merida actually received $124 million.
“I always get agencies that ask me to swap patients with them,” a hospice CEO said. Centers for Medicare & Medicaid Services (CMS) has introduced a series of new regulations to combat fraud during the past two years. Medicare claims data shows that 102 newly enrolled hospices entered California in 2023.
The health care system, in both private and public settings, that is engaged with financing, managing, and providing palliative and hospicecare must directly address the issue of racism, discrimination, and disparities, particularly among marginalized underserved non-Hispanic Blacks,” authors stated in the study.
Department of Justice (DOJ) is prioritizing hospice as the agency cracks down on health care fraud. DOJ counts hospice claims among the root causes of rising Medicare costs in recent years, according to Lisa Miller, deputy assistant attorney general overseeing the department’s Crime Fraud Section. million.
SEIU analyzed Medicare claims data showing that the average hospice transfer rate among HCA hospital discharges was nearly 40% above the national average in 2021 and represented a 50% growth rate over four years. For one, hospice utilization has been on a steady upswing nationally for several years. told Hospice News.
He previously served as president of the National Association for Home Care & Hospice (NAHC) for 38 years prior to its affiliation with the National Hospice and Palliative Care Organization (NHPCO) in 2023 and was heavily involved in the establishment of the MedicareHospice Benefit.
Cameron Muir has been named as the new CMO of the National Partnership for Healthcare and Hospice Innovation (NPHI). His new title signals the organization’s strategic plans to reshape hospicecare delivery through patient-centered, innovative approaches, according to NPHI CEO Tom Koutsoumpas. “We
Research around hospicecare has come a long way. But data gaps exist when it comes to expanding understanding of some aspects of end-of-life care delivery. A range of researchers has amassed a growing base of data on hospice, with some common themes tied to quality outcomes, costs, length of stay and general inpatient care.
For example, data gathered from predictive analytics systems can give hospices an advantage when it comes to performance on measures like Hospice Visits in the Last Days of Life (HVLDL) and the HospiceCare Index (HCI), as well as predicting when patients become hospice eligible or will be in need to home health or palliative care services.
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