In July 2023, the Centers for Medicare and Medicaid Services (CMS) announced increased scrutiny on hospice ownership and physician medical directors to combat hospice fraud and abuse. The vulnerable status of hospice patients has prompted CMS and the Department of Justice (DOJ) to prioritize their protection. A dozen hospice agencies have entered Corporate Integrity Agreements (CIAs) with the Department of Health and Human Services to avoid exclusion from federal healthcare programs, and DOJ has negotiated $266.5 million in hospice-related settlements since 2012.
The 2024 Home Health Prospective Payment System Proposed Rule extends strict enrollment screening and billing privilege transfer restrictions to hospice agencies. CMS is implementing enhanced oversight periods for new hospices and ownership transfers in certain states due to increased fraud and abuse reports. The oversight ranges from 30 days to 12 months, with possible pre-payment claim reviews. LBMC offers hospice business valuations and consultation for various ownership transactions.
Nicholas A. Newsad, MHSA works in the Advisory Services Group at LBMC. He can be contacted at nick.newsad@es-one.com or 615-309-2489.