CMS's Reliance on Puerto Rico's Certification Surveys Could Not Ensure the Quality of Care Provided to Medicare Hospice Beneficiaries by Servicios Suplementarios de Salud, Inc.

CMS's reliance on the Puerto Rico Department of Health's (health department) certification surveys could not ensure the quality of hospice care that Servicios Suplementarios de Salud, Inc. (Servicios), provided to Medicare beneficiaries. Specifically, we found that Servicios did not always meet certain Federal and Commonwealth requirements for professional licensing and certification, criminal background checks, health certificates, and training. Of the 170 workers included in our review, 130 workers' personnel records did not contain documentation to support compliance with 1 or more Federal and Commonwealth requirements. In addition, Servicios did not have any personnel records for five workers who provided direct care to Medicare beneficiaries. The health department's most recent certification survey did not find any of the types of deficiencies identified in this report; therefore, CMS's reliance on health department surveys could not ensure quality of care and that adequate protection was provided to Medicare beneficiaries.

To improve protection provided to Medicare hospice beneficiaries, we recommended that CMS work with the health department to ensure that Servicios meets all Federal and Commonwealth requirements for professional licensing and certification, criminal background checks, health certificates, and training. The health department did not address our findings. CMS concurred with our recommendation.