Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity: An OIG Portfolio

The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services has released a study on Medicare's Hospice Program, identifying vulnerabilities and presenting recommendations for protecting beneficiaries and other improvements. OIG found that hospices do not always provide needed services to beneficiaries and sometimes provide poor quality care. In some cases, hospices were not able to effectively manage symptoms or medications, leaving beneficiaries in unnecessary pain for days. OIG also found beneficiaries and their families and caregivers do not receive crucial information to make informed decisions about their care. Further, hospices' inappropriate billing costs Medicare hundreds of millions of dollars. The current payment system also creates incentives for hospices to minimize their services and seek beneficiaries who have uncomplicated needs. OIG recommends that CMS strengthen the survey process—its primary tool to promote compliance—to better ensure that hospices provide beneficiaries with needed services and quality care. CMS should also seek statutory authority to establish additional remedies for hospices with poor performance. CMS should educate beneficiaries and their families and caregivers about the hospice benefit, working with its partners to make available consumer-friendly information. To reduce inappropriate billing, CMS should strengthen oversight of hospices. Lastly, CMS should take steps to tie payment to beneficiary care needs and quality of care to ensure that services rendered adequately serve beneficiaries' needs, seeking statutory authority if necessary.