CMS Considers Nationwide Pause on New Hospice Provider Enrollments

The U.S. Centers for Medicare & Medicaid Services (CMS) is contemplating a nationwide pause on new hospice provider enrollments amidst growing concerns over fraudulent activities within the sector. This consideration follows a formal request by the National Partnership for Healthcare & Hospice Innovation (NPHI), which is urging CMS to implement such a moratorium to protect Medicare’s hospice benefits from exploitation by unscrupulous entities.

In a communication to CMS officials, including Administrator Dr. Mehmet Oz, NPHI founder and CEO Tom Koutsoumpas emphasized the need for immediate action against fraudulent operators. The organization suggests reforms such as conducting targeted audits on lower-quality providers to ease the compliance burden on legitimate hospice services. These measures aim to preserve the integrity of the Medicare system while ensuring the enforcement of regulatory standards.

Further recommendations from NPHI include adjusting the hospice aggregate cap to prevent excessive profit margins and enhance wage considerations, as well as providing patients with benefit explanation documents upon enrollment to increase transparency. The organization also advocates for regular operational checks to ensure providers uphold industry standards, including business legitimacy verifications. Koutsoumpas highlighted the frustration of ethical providers over the potential damage to public trust caused by fraudulent actors, underlining the importance of maintaining the integrity and trust of hospice care services.