Medicare Could Be Paying Twice for Prescription Drugs for Hospice Beneficiaries

The U.S. Department of Health and Human Services Office of Inspector General (OIG) found that during calendar year 2009, Medicare Part D paid for certain drugs twice for beneficiaries in Hospice.

“As a result, the Medicare program could be paying twice for prescription drugs for hospice beneficiaries: once under the Medicare Part A hospice per diem payments and again under Medicare Part D,” said the OIG report. 

In order to be eligible for Medicare hospice care, a beneficiary must be entitled to Part A of Medicare and be certified as terminally ill (i.e., having a medical prognosis that life expectancy is 6 months or less if the disease runs its normal course). Under the Medicare Part D program, individuals entitled to benefits under Medicare Part A may obtain voluntary coverage for prescription drugs.

The OIG recommended that CMS educate sponsors, hospices, and pharmacies that it is inappropriate for Medicare Part D to pay for drugs related to hospice beneficiaries’ terminal illnesses and perform oversight to ensure that Part D is not paying for drugs that Medicare has already covered under the per diem payments made to hospice organizations.

View the report here

Written by John Yedinak

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