Recently published findings from an audit of Medicaid and Medicare hospice providers found that 90% of those randomly sampled did not meet state hospice licensure requirements related to hospice workers.
The Department of Health and Human Services Office of Inspector General conducted an audit to determine whether the Centers for Medicare & Medicaid Services’ (CMS) reliance on Illinois licensure requirements for hospice workers were being met.
The department reviewed a sample of 120 Medicaid hospice claims from a total of 56,044 claims paid to Illinois hospices between Jan. 1, 2009, and Dec. 31, 2010.
For these 120 claims, the department reviewed the qualifications of the 613 corresponding hospice workers, from 42 hospices, who provided direct care to the Medicaid beneficiaries during the month. One-hundred and ten claims involved direct care provided by unqualified hospice workers.
“On the basis of these sample results, we estimated that 51,374 of the 56,044 claims covered by our review were associated with unqualified hospice workers,” the department reports.
Licensure requirements not met included initial health evaluation requirements (110 claims), background check requirements (20 claims), training requirements (17 claims), personnel file requirements (12 claims), written job description requirements (five claims) and hospice worker certification requirements (two claims).
The department recommends that CMS works with the state of Illinois to ensure hospices meet state requirements for hospice workers and consider working with the state agency to modify the agency’s hospice payment conditions, according to the audit.
Written by Cassandra Dowell