OIG focuses on life expectancy in latest hospice audit

The Department of Health and Human Services Office of Inspector General (OIG) has suggested a hospice provider in Fairfield, Calif., repay $3.3 million to Medicare after its latest audit.

The report, released earlier this month, alleged 21 of the 100 sampled claims over a two-year period did not support the associated beneficiary’s terminal prognosis.

“Specifically, the independent medical review contractor determined that the records for these claims did not contain sufficient clinical information and other documentation to support the medical prognosis of a life expectancy of 6 months or less if the terminal illness ran its normal course,” according to the OIG report.

Professional Healthcare disagreed with the OIG determinations for all 21 questioned sampled claims but agreed to return any overpayment for one claim for which the beneficiary’s clinical record lacked documentation of a required face-to-face encounter.

Read the full report.