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As of July 2005, 14% of Medicare hospice providers were overdue for certification, according to an HHS Office of Inspector General report released 24Apr. [AP/Houston Chronicle].

The report used data from a 2005 survey of 2,537 active hospices. According to the report, hospices overdue for certification had not been surveyed for an average of nine years — three years longer than the standard time set by CMS. Hospices in California, Illinois and Michigan accounted for 41% of the overdue certifications, the report found.

Health deficiencies, such as insufficient patient care plans, were found in 46% of the hospices surveyed. Medicare payments in 2004 to hospices overdue for inspection averaged $2.7 million each, according to the report.

The only way the federal government can discipline a hospice found to have patient care problems is to eliminate it from the Medicare program, whereas nursing homes can be fined or eliminated from the program. The report recommends establishing other means of enforcing rules for hospices.

In addition, HHS Inspector General Daniel Levinson in a statement said, “Hospice facilities should be surveyed timely so that problems can be detected and addressed.” The frequency of hospice inspection is set by CMS as part of its budget process. From fiscal year 2000 to 2005, hospices were set to be inspected every six years, but the requirement was changed to eight years in 2006.

Judi Lund Person of the National Hospice and Palliative Care Organization said, “We’ve been calling for more frequent surveys for some time.” She added that such surveys give “a chance to make sure providers and staff know what regulators are looking for” (Johnson, AP/Houston Chronicle, 4/25).

[This is not surprising. The government provides very little oversight over the hospice industry. They basically can do whatever they want, and no state inspector or even the police will do anything. Standards of care can be violated with impunity as they know “nobody is watching!” R Panzer, HPA, 25Apr 2007]