The Centers for Medicare & Medicaid Services (CMS) and its audit contractors have the authority to suspend payments to hospice care providers suspected of submitting false claims or improperly retaining overpayments of taxpayer dollars. While payment suspensions are intended to help eliminate fraud under the Medicare program and Medicaid program, they can have serious financial consequences for providers—and, in far too many cases, these suspensions are unwarranted.
When hospice care provider audits lead to the issuance of payment suspension notices, targeted providers need to respond promptly and effectively. Depending on the circumstances, their Medicare enrollment or Medicaid enrollment could potentially be at risk as well—and allegations of suspected fraud can lead to criminal investigations in some cases.
“Hospice care providers that serve Medicaid and Medicare beneficiaries need to prioritize billing compliance. Auditors use claims data mining, on-site inspections, and other means to uncover evidence of suspected billing violations, and allegations of receiving improper payments can lead to payment suspensions and other serious consequences.” – Dr. Nick Oberheiden, Founding Attorney of Oberheiden P.C.
Medicare and Medicaid suspensions are temporary by definition; and, when a suspension ends, the suspended funds are first applied to any overpayments (as determined by CMS or a CMS auditor). As a result, even once a suspension is over, this isn’t necessarily the...
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