CMS has spent $255.1 million on payments for hospice patients who didn’t meet program eligibility requirements, according to a HHS Office of Inspector General (OIG) report published June 23. 
 
Of 100 randomly selected initial certification periods that occurred in fiscal year 2021, the OIG found that 45 were connected to improper payments. The medical records for 21 of these periods did not support that the beneficiary had a terminal illness, while the other 24 did not meet related documentation expectations. 
 
To prevent the further distribution of unallowed payments, the OIG suggested that CMS and hospice Medicare Administrative Contractors (MACs) work to strengthen hospice eligibility checks, including implementing pre- or post-payment reviews.