Hospice industry blasts OIG’s final compliance program
Hospice industry blasts OIG’s final compliance program
By MATTHEW HAY
HHBR Washington Correspondent
BALTIMORE Hospice representatives say the Depart ment of Health and Human Services’ (Wash ington) Office of Inspector General’s (OIG) final compliance program for hospice incorporates few of the changes they were hoping for when they submitted comments on the draft plan released July 21. The OIG’s compliance program for hospice is similar to other guidance already issued by the OIG for clinical laboratories, hospitals, home health agencies, third-party medical billing companies, and durable medical equipment suppliers. While all OIG compliance programs are voluntary, they serve to put healthcare providers on notice about potential violations.
Once considered a domain largely free of fraud and abuse, the OIG has put hospice on notice about potential trouble spots. According to Karen Woods of the Hospice Association of America (HAA; Washington), many of those risk areas have never been substantiated.
For example, the OIG wants hospices to develop standards of conduct for "all affected employees," including "affiliated providers operating under the hospice’s control." But HHA argues that many of these providers are rarely, if ever, affiliated with hospices and under the hospice’s control. "This is particularly true of attending physicians," HHA argued in response to the OIG’s draft. "It is unrealistic to expect that a hospice program could assure that these providers adhere to the hospice’s standards of conduct."
The industry also argued that the OIG is trying to apply a "one-size-fits-all" plan to an industry that is marked by considerable diversity. However, the OIG maintains that it understands "the variances and complexities" within the hospice industry and is sensitive to the differences among large national and regional multi-hospice organizations, small independent hospices, and others. Regardless of those distinctions, the OIG concluded in its final plan, every hospice "can and should" strive to accomplish the objectives and principles underlying all of the compliance policies and procedures recommended in the guidance.
When it comes to compliance, Woods said, there are no silver bullets for hospice providers. "You have to be cautious about kickbacks and review your admissions process and make sure you are following the conditions of participation," she said.
Providers should pay close attention to fundamentals, including contractual relationships and conditions of participation, as well as anything that might give the appearance of paying for referrals, said Woods. "It also means not providing care that is so far below market value that you are giving it away," she added. That can be a particular challenge for hospice because of the nature of the business, according to Woods. "A lot of it is free service and indigent care," she explained. "But you have to make sure that care is appropriate for that patient and the need is there." Providers can get tripped up if it appears the care is actually an enticement.
"It is almost impossible in some cases to document everything," warned Woods. But hospice providers should make sure there is appropriate documentation reviewed by a physician and that local medical policies are adhered to, she pointed out. With a disease other than cancer, there are certain clinical markers, she added. "Make sure that all those steps are taken and it is not just an offhand statement from the physician," she said.
The complete hospice compliance program guidance is available on the Internet at www.hhs.gov/oig.
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