Audit of Beneficiary Hospice Eligibility at Samaritan Care, Inc., Lansing, Illinois

This final audit report points out that of 224 beneficiaries who had been in hospice care at Samaritan Care, Inc. for more than 210 days, 213 beneficiaries were not eligible for hospice coverage. As a result, Medicare overpayments to Samaritan for these beneficiaries amounted to more than $10.4 million. The beneficiaries were ineligible because medical determinations, made by physicians under contract to the Illinois Medicare peer review organization found the medical evidence in the files showed that the beneficiaries did not have terminal conditions resulting in life expectancies of 6 months of less. Because of pending criminal and civil actions against the previous owner of Samaritan, we are not making a recommendation for the Health Care Financing Administration to independently recoup the $10.4 million in identified overpayments. We are, however, recommending improved controls to help preclude abusive practices.