Kusserow on Compliance: OIG releases two reports questioning quality of hospice care

80% surveyed hospices had deficiencies

Many cases of harm to beneficiaries cited

The OIG released two reports which found hospices participating in Medicare had one or more deficiencies in the quality of care they provided to their patients. The OIG cited cases where beneficiaries were seriously harmed by poor care or facilities failed to act in cases of abuse. In its reports, the OIG made several recommendations to strengthen safeguards.

In one report—Hospice Deficiencies Pose Risks to Medicare Beneficiariesthe OIG identified significant vulnerabilities in the Medicare hospice benefit and found over 80 percent of these hospices had at least one deficiency. These included poor care planning, mismanagement of aide services, and inadequate assessments of beneficiaries. Over 20 percent of hospices had a serious “condition-level” deficiency, which means that “the hospice’s capacity to furnish adequate care is substantially limited or adversely affects the health and safety of patients.” The OIG called upon CMS to: (1) strengthen the survey process; (2) establish additional enforcement remedies; (3) provide more information to beneficiaries and their caregivers; (4) expand the deficiency data that accrediting organizations report to CMS to strengthen its oversight of hospices; (5) seek statutory authority to include information from accrediting organizations on Hospice Compare; (6) include on Hospice Compare the survey reports from State agencies; (7) include on Hospice Compare the survey reports from accrediting organizations, once authority is obtained; (8) educate hospices about common deficiencies and those that pose particular risks to beneficiaries; and (9) increase oversight of hospices with a history of serious deficiencies.

In its second report—Safeguards Must Be Strengthened To Protect Medicare Hospice Beneficiaries From Harm—the OIG described specific instances of harm to hospice beneficiaries and identified vulnerabilities in CMS’s efforts to prevent and address harm. Some instances of harm resulted from hospices providing poor care to beneficiaries and some resulted from abuse by caregivers or others and the hospice failing to act. Cases revealed vulnerabilities in beneficiary protections that CMS must address. The OIG called for CMS to: (1) seek statutory authority to establish additional, intermediate remedies for poor hospice performance; (2) strengthen requirements for hospices to report abuse, neglect, and other harm; (3) ensure that hospices are educating staff to recognize signs of abuse, neglect, and other harm; (4) strengthen guidance for surveyors to report crimes to local law enforcement; (5) monitor surveyors’ use of immediate jeopardy; and (6) improve and make user-friendly the process for beneficiaries and caregivers to make complaints.


Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2019 Strategic Management Services, LLC. Published with permission.