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Nationwide Review of Hospice Beneficiary Eligibility

Announced on  | Last Modified on  | Project Number: A-06-22-09003
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Hospice care can provide comfort to beneficiaries, families, and caregivers at the end of beneficiarie's lives. To be eligible for hospice care, they must be entitled to Medicare Part A and be certified as being terminally ill. The certification of terminal illness for hospice benefits shall be based on the clinical judgment of the hospice medical director or physician member of the interdisciplinary group, and the beneficiarie's attending physician, if they have one, regarding the normal course of their illness. OAS has performed several compliance audits of individual hospice providers in recent years, and each of those audit reports identified findings related to beneficiary eligibility. We will perform a nationwide review of hospice eligibility, focusing on those hospice beneficiaries that haven't had an inpatient hospital stay or an emergency room visit in certain periods prior to their start of hospice care.

TIMELINE

  • January 22, 2022
    Announced
  • June 18, 2026
    Complete

    Nationwide Review of Hospice Beneficiary Eligibility complete. Report Published

REPORT PUBLISHED

Medicare Could Have Saved $255.1 Million Related to Hospice Services for Certain New Hospice Enrollees (A-06-22-09003)
Recommendations are updated each month and may not immediately be available for recently completed projects.
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Departmental Operational Issues Financial Stewardship Non-institutional care
Target Groups
-
Financial Groups
Medicare A