Surveyors Become Hospice Fraud Busters!
The primary job of surveyors is to determine whether providers have complied with Medicare Conditions of Participation (CoPs).? In a memo to state survey agency directors dated November 13, 2024, however, the Centers for Medicare and Medicaid Services (CMS) says that surveyors will now be asked to identify instances of potential fraud.? Specifically, state surveyors will review recent changes in ownership and verify that providers have related documents as proof of compliance, including review of Forms 855A, Medicare enrollment applications.? Surveyors will also review possible instances of unapproved changes in location and will be expected to review corporate governance issues.?
In other words, surveyors will now help ensure Medicare program integrity through enrollment oversight, identification of fraudulent providers, and minimizing fraudulent activity.? Providers may be appropriately concerned about this development.? Provider enrollment issues, including changes in location, are handled in detail by the Provider Enrollment/Program Integrity staff at CMS.? It is likely a waste of time and resources to review those issues again with surveyors.?
Perhaps their greatest concern is that it does not appear that any specialized training will be provided to surveyors regarding the above issues.? Specifically, the memo says that surveyors receive the following training:
In other words, no specialized training will be provided to surveyors to help ensure that they are capable of dealing with these issues.? Anecdotally, there are many instances in which surveyors lack the knowledge to understand provider enrollment and governance issues, but the consequences of misunderstandings for providers may be severe.?
Surveyors are required to referrals to CMS if they uncover possible evidence or concerns about fraud during surveys. Based upon these reports, the following enforcement actions may be taken:
In other words, lots of time and money are likely to be involved!
Providers must be proactive during surveys, including involving legal counsel to “head off at the pass” erroneous understandings by surveyors to avoid the severe consequences described above.
Regulators and enforcers are appropriately concerned about fraudulent activities in the hospice industry, but enforcement action must be based on accurate knowledge.
You can read the entire memo here: https://www.cms.gov/files/document/qso-25-06-hospice.pdf
?2024 Elizabeth E. Hogue, Esq.? All rights reserved.
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