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Medicare Payments of $6.6 Billion to Nonhospice Providers Over 10 Years for Items and Services Provided to Hospice Beneficiaries Suggest the Need for Increased Oversight

Our analysis of trends and patterns in payments for items and services provided to Medicare beneficiaries outside the Medicare hospice benefit during a hospice period of care (which we refer to as "nonhospice payments") demonstrate an increase in Medicare nonhospice payments for beneficiaries. Nonhospice payments for Medicare Part A services and Part B items and services totaled $6.6 billion from 2010 through 2019. If providers bill Medicare for nonhospice items and services that potentially should be covered by hospices, Medicare could pay for the same items or services twice.

Our prior work on Medicare Part D drugs and durable medical equipment, prosthetics, orthotics, and supplies provided to hospice beneficiaries demonstrated that these duplicate payments are, in fact, occurring. In three prior reports, we made several recommendations to CMS to establish oversight and scrutiny of Medicare nonhospice payments. Implementing the recommendations from those reports and considering the information in this data brief may help the Centers for Medicare & Medicaid Services (CMS) further evaluate the need to potentially restructure the hospice payment system to reduce duplicate payments for items and services that should be included in the hospice per diem payment. The information in this data brief may also help CMS determine whether the hospice benefit is operating consistent with its longstanding position that services unrelated to a hospice beneficiary's terminal illness and related conditions should be exceptional, unusual, and rare given the comprehensive nature of the services covered under the Medicare hospice benefit.

Because this report contains no recommendations, CMS did not provide written comments on our draft report but did provide technical comments, which we addressed as appropriate.

Filed under: Centers for Medicare and Medicaid Services