HJAR Mar/Apr 2023

from newly certified hospices that run the gamut of wasting taxpayer dollars to put- ting vulnerable patients in danger,”the letter states. “The various instances of gaming the system and harming patients raises a num- ber of questions about how the hospice ben- efit is currently implemented and how the federal government can better partner with stakeholders and state agencies to stop this going forward.” The letter from the House is the latest instance of lawmakers asking CMS to pro- tect dying patients and their families. In December, three weeks after the publica- tion of the ProPublica-NewYorker exposé, a bipartisan group of senators sent their own letter to Brooks-LaSure noting that “further evidence of apparent Medicare fraud can- not be ignored.” Both sets of lawmakers have requested briefings from CMS on the agency’s plans to penalize bad actors and what additional authority, if any, it will need from Congress to carry them out. “Hospice can be an important part of a patient’s care, but only if it is operating as intended,” the representatives wrote in the letter sent last week. “We stand ready to work with CMS to ensure that this con- tinues to be a safe option for patients while ensuring that congressional oversight is car- ried out.” Industry leaders have echoed these concerns. In an effort hailed by experts as “unusual and impressive,”the national trade associations for palliative care providers have banded together to advocate for more regulation. Just last week, the groups met with Brooks-LaSure to discuss a joint list of 34 recommendations for strengthening program integrity. At the meeting, the trade groups spoke to CMS about developing a list of “red flag criteria” that would trigger additional scrutiny before hospice owners could start billing Medicare. The groups also reiterated their suggestion that the agency implement a targeted ban on new hospices in high-growth areas. ACMS spokesperson told ProPublica that the agency “takes the oversight role of the Medicare hospice program seriously and is aggressively focused on reducing and elimi- nating fraud, waste and abuse.” n Regulators Overhaul Inspections of Hospice Providers by Ava Kofman, ProPublica This story was originally published by ProPublica, February 22, 2023. A report last year from ProPublica and The New Yorker revealed a $22 billion hospice industry rife with fraud and exploitation. CMS announced reforms that go into effect immediately.