Last week, the Department of Health and Human Services – Office of Inspector General (“OIG”) released a portfolio report identifying multiple vulnerabilities in the Medicare Hospice Program (the “Hospice Portfolio Report”), including concerns around billing, federal oversight, and quality of care. The OIG made 16 recommendations to CMS to strengthen the hospice program; CMS only concurred with 6 of the recommendations.

Notwithstanding CMS’ non-concurrence to the majority of the OIG’s recommendations, these findings may preview increased enforcement actions in the hospice space. In recent years, the OIG has released two other portfolio reports: one on vulnerabilities in Medicaid personal care services (“PCS”) and a second on the Medicare Part D program. Following the release of each of these reports, the number of reported investigations and prosecutions in the affected spaces surged. For example, since the OIG’s release of its report on PCS in 2012, the OIG has opened more than 200 federal criminal investigations involving fraud and patient harm by PCS providers; state investigations similarly increased.

This post outlines the OIG’s findings and recommendations related to hospice program vulnerabilities, as well as what these findings and recommendations may mean for hospice providers. Continue Reading The OIG Identifies “Significant Vulnerabilities” in the Medicare Hospice Program: What This Might Mean for Hospice Providers?

At yesterday’s Public Health Council meeting, the Massachusetts Department of Public Health (DPH) released yet another round of proposed regulatory amendments.  On deck were regulations concerning Long Term Care Facilities, Hospice Programs, and Temporary Nursing Service Agencies, as well as requirements for Training of Nurses’ Aides in Long-Term Care Facilities.  Also presented were updated regulations on the Drug Formulary Commission (formerly List of Interchangeable Drug Products regulations).  Senior DPH staff presented the proposed regulations, highlighting key objectives. Council members were highly engaged in the discussions, asking numerous questions and offering comments.  Commissioner Monica Bharel, MD, MPH, commended DPH staff for their hard work on the amendments and the Council for its support of these ongoing efforts. Continue Reading Massachusetts Regulatory Overhaul Continues

Emboldened by significant electoral gains in the 2010 midterm elections, Republican lawmakers have devoted significant time and attention to repealing “Obamacare.”  Known officially as the Affordable Care Act (“ACA”), their efforts led to only very minor modifications in the law. That may be changing, due the targeting of the Community Living Assistance Services and Supports (CLASS) Act by Republican lawmakers. Established by the ACA, CLASS is a long-term care insurance program that would provide working adults the option of a benefit to cover non-medical services and supports in the case of physical and/or cognitive limitations.

Championed by the late Senator Ted Kennedy (D-MA), CLASS has long been one of the top targets for Republican lawmakers who deem it financially irresponsible.  And despite past, vehement support for it by top Democrats, there is growing recognition that the program could pose an excessive financial burden on our health care system. Even the administration’s National Commission on Fiscal Responsibility and Reform, chaired by former President Clinton White House Chief of Staff Erskine Bowles and former Sen. Alan Simpson (R-WY), called last December for the reform or repeal of CLASS due to projections that benefits would outpace premiums. GOP leaders on the House Energy & Commerce Committee released their own report last month, which criticized Democrat support for the program even after revelations of its potential financing problems.

Recently, rumors circulated that HHS had decided to shut down the office responsible for overseeing CLASS. It has remained open, albeit with a smaller staff. But HHS Assistant Secretary of Aging Kathy Greenlee addressed the criticism on September 28th, saying that a final decision on the program would be made in mid-October.  Unsatisfied, Energy & Commerce Republican leaders wrote a letter to HHS Secretary Kathleen Sebelius on October 5th demanding a report on the viability of CLASS by no later than yesterday.  While the Secretary’s response has not yet been made public, it is fair to assume that she is on the defensive on this subject.

Although most observers now believe that the Secretary will be forced to abandon efforts to implement the CLASS program, it remains to be seen whether lawmakers might come together to design a new, bipartisan CLASS Act. The need is clear, as unreimbursed long-term care is one of the largest expenses for families whose loved ones suffer from chronic physical or cognitive limitations. If implementation of CLASS is halted, Republicans will likely claim victory in repealing an overreach by the federal government, and Democrats will likely lament it as a casualty of fiscal uncertainty and political divisiveness.  However, the burdens presented by long-term care will still be too high on too many Americans, and both parties should recognize that talking points fall short of real health care solutions.