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Duplicate Drug Claims for Hospice Beneficiaries

Hospice providers are required to render all services necessary for the palliation and management of a beneficiary’s terminal illness and related conditions, including prescription drugs. Medicare Part A pays providers a daily per diem amount for each individual who elects hospice coverage, and part of the per diem rate is designed to cover the cost of drugs related to the terminal illness. Accordingly, Medicare Part D drug plans should not pay for prescription drugs related to a hospice beneficiary’s terminal illness because the drugs are already included in the Part A hospice benefit. Previous OIG work (A-06-10-00059) found that Medicare may have paid twice for prescription drugs for hospice beneficiaries, once under the Part A per diem rate and again under Part D. We will follow up on this work and review the appropriateness of Part D drug claims for individuals who are receiving hospice benefits under Part A. We will also determine whether Part D continues to pay for prescription drugs that should have been covered under the per diem payments made to hospice organizations.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
August 2017 Centers for Medicare & Medicaid Services Duplicate Drug Claims for Hospice Beneficiaries Office of Audit Services W-00-17-35802; A-06-17-xxxxx 2018

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