CMS says it is expanding its increased scrutiny of hospice providers in select states due to fraud concerns.
CMS announced Sept. 5 that it will expand prepayment medical review in Arizona, California, Nevada and Texas “to combat fraud, waste, and abuse under the hospice benefit.”
To help reduce burden on compliant providers, initial review volumes will be low and adjusted based on results, CMS noted in a brief message announcing the move. “If you’re noncompliant, we may implement extended review or take additional administrative actions.”
In a message to its members, the National Association for Home Care & Hospice said it was seeking clarity from CMS on whether this includes the existing group of “new hospice providers,” all hospice providers or another subset of providers.
In July 2023, CMS launched a “period of enhanced oversight” for new hospices in the four states.
Officials pointed at the time to a year’s worth of reports of hospice fraud, waste and abuse. “The number of enrolled hospices also has increased significantly in these states, raising serious concerns about market oversaturation,” CMS noted at the time.
The period of enhanced oversight includes medical review such as prepayment review. That period could last anywhere from 30 days to a year.