OIG to Revisit Potential Duplicate Medication Payments through Hospice/Part D
August 18, 2017 03:21 PM
As referenced previously in NAHC Report, the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) has – on a biannual basis -- issued its Work Plan outlining its ongoing investigations. In an effort to increase transparency, beginning in June 2017 the OIG began issuing monthly updates to its Work Plan. In June and July, a number of new items of interest to home care and hospice providers were announced, which were reported upon on July 21. Most recently, the OIG released information about newly-added initiatives, which include a notice that it intends to continue study of potential duplicate payments for prescription medications while patients are on hospice care. Following is the description that was released:
Hospice providers are required to render all services necessary for the palliation and management of a beneficiary’s terminal illness and related conditions, including prescription drugs. Medicare Part A pays providers a daily per diem amount for each individual who elects hospice coverage, and part of the per diem rate is designed to cover the cost of drugs related to the terminal illness. Accordingly, Medicare Part D drug plans should not pay for prescription drugs related to a hospice beneficiary’s terminal illness because the drugs are already included in the Part A hospice benefit. Previous OIG work (A-06-10-00059) found that Medicare may have paid twice for prescription drugs for hospice beneficiaries, once under the Part A per diem rate and again under Part D. [OIG] will follow up on this work and review the appropriateness of Part D drug claims for individuals who are receiving hospice benefits under Part A. We will also determine whether Part D continues to pay for prescription drugs that should have been covered under the per diem payments made to hospice organizations.
A report on this latest hospice-Part D inquiry, to be conducted by the OIG Office of Audit Services, is expected during FY2018, with the following report numbers: W-00-17-35802 and A-06-17-xxxxx.
For additional information related to the OIG Work Plan, please go here. For NAHC Report articles covering the initial OIG Work plan for FY2017, which was issued in November, please see the following:
Office of Inspector General 2017 Work Plan for Home Health Released
Office of Inspector General 2017 Work Plan for Hospice Released