The U.S. Department of Justice (DOJ) is prioritizing hospice as the agency cracks down on health care fraud. Increased reimbursement oversight could be on the horizon, lending to a potential rise in whistleblower cases.
DOJ counts hospice claims among the root causes of rising Medicare costs in recent years, according to Lisa Miller, deputy assistant attorney general overseeing the department’s Crime Fraud Section.
This is among the reasons that hospice fraud is among the top priorities for the regulatory agency, Miller indicated during the American Bar Association’s 33rd Annual National Institute on Health Care Fraud.
“The Health Care Fraud Unit and its partners are prioritizing the investigation and prosecution of schemes that affect vulnerable populations, including, but by no means limited to, sober homes fraud, illegal prescribing of controlled substances and hospice fraud,” Miller said. “In recent years, data has shown an increase in costs to the Medicare program resulting from claims for hospice care.”
Fraudulent or inaccurate Medicare claims cost the federal government an estimated $60 billion annually, according to a 2018 CNBC report. Medicare hospice claims represent a solid chunk, according to regulators.
For instance, roughly one-third (31%) of general inpatient hospice stays in 2012 were billed inappropriately, a $268 million cost to Medicare, the U.S. Department of Health and Human Services Office of the Inspector General (OIG) ...
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