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Feds: Hospices must get proper patient certifications from physicians

In its annual report from the 2015 fiscal year, the Department of Health and Human Services’ Office of Inspector General had some criticism for hospices.

The feds urged that hospice providers need to do a better job of making sure that physicians provide proper certification when a Medicare beneficiary is eligible for hospice care.

The report, which was release last month, stated that physicians did not meet the requirements needed for certifying a Medicare beneficiary for hospice care in 14 percent of inpatient hospices that were audited as part of the report.

The OIG stated that physicians must completely explain the clinical findings that support the determination that the Medicare beneficiary has six months or less to live. An example provided by the OIG of the requirements not being met simply stated “resp. failure dying,” McKnight’s Long-Term Care News reported.

The OIG has strict rules for certifying beneficiaries for hospice care in effort to avoid Medicare fraud. The OIG is cracking down on hospices that submit fraudulent claims for Medicare beneficiaries who should not have been in hospice care.

The OIG’s report also showed that there were 1,553 convictions, 731 civil settlements and $744 million in criminal and civil sanctions throughout the country for Medicaid fraud in fiscal year 2015. As you can see, the feds are not taking the issue lightly.

Unfortunately, there are many hospice companies that end up in trouble with the law unintentionally. The health care regulations are more complex than ever, and it can be difficult for non-lawyers to ensure that their businesses are in compliance.

For that reason, numerous hospice businesses are turning to health care lawyers for proactive advice on federal and state regulation compliance, as well as representation in situations involving investigations and Medicare overpayment appeals.

Keep reading for more information on getting legal assistance with these matters.