Anti-personnel landmines in the hospice regulatory landscape

Hospice caregivers navigate a minefield of today’s regulatory environment to avoid getting caught up in a mix of fraudulent activities in the space.

According to Patrick Harrison, senior director of regulatory and compliance at the National Hospice and Palliative Care Organization (NHPCO), the current state of hospice regulations leaves providers teetering on the edge of compliance.

Fraud, waste and abuse occur in several different industries, and healthcare is no exception. However, most hospices strive to provide high-quality end-of-life experiences for terminally ill patients and their families, Harrison told the Hospice News Elevate conference in Washington, D.C. Regulators need to keep this in mind when shaping hospice regulations to avoid limiting and said it limits providers’ capabilities to develop and innovate in the delivery of end-of-life care.

“Program integrity continues to be a tragic issue for hospice,” Harrison told Hospice News. “This is an issue that continues to damage hospice. There is concern that this could be harmful and could undermine the decision of beneficiaries and their families to choose hospice services for fear of fraud occurring. We definitely want to get rid of it. In fact, we want to move on from this fraud so that it no longer destroys the great work that providers do and continue to do serving patients, families and communities.”

Fighting for program integrity

Concerns about the integrity of hospice programs are growing as cases of fraud, waste and abuse emerge across the industry.

Fraudsters have defrauded Medicare out of millions, and in some cases they have faced criminal charges and even prison time. The fraudulent activity involved enrolling ineligible patients, often without their knowledge or consent. In other cases, among other violations, hospice patients did not receive care for paid services.

Hospice scams have spread to some states such as Arizona, California, Nevada, and Texas. The abuse included increasing the number of new providers without a corresponding increase in the eligible patient population. In some cases, multiple hospices operate at the same address.

The quality of care provided (or lack thereof) was so outrageously poor that patients suffered at the end of life, leaving behind complicated experiences of grief among their families.

While increased regulatory oversight in response to the fraudulent activity was warranted, it resulted in some unintended negative consequences for both providers and patients, according to Pamela Duncan Owens, chief compliance officer at Agape Care, a hospice and palliative care provider based in South Carolina .

Duncan pointed out that bad actors have made the path to compliance complicated even for legitimate hospice providers. She said a single low-quality provider could raise concerns and potentially prevent access to much-needed increased end-of-life support among terminally ill populations.

“There are some that are wasting resources, committing fraud, abusing government and payer services and resources,” Duncan told Hospice News at the conference. “There are some companies that bill for services that were not performed or for services that should not have been performed. This one nucleus, good or bad, (creates) the environment we have. And we (who) are clearly not, proceed to the preliminary analysis, whether it is fair or not.

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Calls for increased supervision over the integrity of the hospice program are becoming louder. Rep. Earl Blumenauer (Oregon) is in the process of drafting the Hospice Care, Accountability, Reform and Enforcement (Hospice CARE) Act. The bill will include provisions aimed at improving quality and reducing fraud in the space industry, Blumenauer told Elevate.

Regulators are taking action, including through increased and more diversified inspection activities in recent years. In a recent national survey of hospice organizations conducted by NHPCO, LeadingAge, the National Association of Home Care and Hospice (NAHC), and the National Partnership for Healthcare and Hospice Innovation (NPHI), more than half of providers nationwide reported undergoing at least many types of audits every year. .

Additionally, the U.S. Centers for Medicare and Medicaid Services (CMS) in its 2024 Hospice Final Rules has included increased penalties for hospices that fail to meet quality reporting requirements. Starting this year, hospices that do not report their performance on quality measures received a 4% payment cut, up from the previous 2%.

According to Lisa Griffee, vice president of quality and customer service at Chesapeake Hospice, to improve regulatory compliance, hospices must focus their staff education efforts on the lasting impact of these regulatory changes on patients and their families. This Maryland-based nonprofit organization provides hospice and supportive care services in four counties in the state.

Griffee said operational and implementation challenges can be accompanied by changes in quality measures. Ensuring that employees are well informed and educated on the evolving regulatory developments that impact their roles and quality outcomes is an important element of both staff satisfaction and compliance,

Accurate documentation is a well-known key to compliance, but instilling awareness of threats and implementing best practices to avoid them can be a difficult process as quality measures evolve, Griffee

“The argument to make to frontline staff about documentation is not documentation to ensure compliance,” Griffee told Hospice News. “You have to frame it as a benefit to the patient and a benefit to the family. What’s the bigger picture? Because many of these ideas are born for the right reason. (It’s) just something that happens along the way and they get distorted. I think we’re getting more interest and we’re able to connect the dots a little better with frontline users who are focused on why it’s important.”