Hospices/Nursing Homes: Medicare/Medicaid Fraud Alert from Inspector General

Legal Eagle Eye Newsletter for the Nursing Profession

  Quick Summary: The Inspector General has issued a Special Fraud Alert for fraudulent and abusive practices in nursing homes' arrangements with hospices that may violate the Medicare/Medicaid anti-kickback statute.

  According to the announcement, specific practices which are suspected kickback schemes include:

  A hospice offering free goods or goods at below market value to induce a nursing home to refer patients to the hospice.

  A hospice paying "room and board" payments to the nursing home in amounts in excess of what the nursing home would have received directly from Medicaid had the patient not been enrolled in the hospice.

  A hospice paying amounts to the nursing home for "additional" services that Medicaid considered to be included in its room and board payment to the hospice.

  A hospice paying above fair market value for additional non-core services which Medicaid does not consider to be included in its room and board payments to the nursing home.

  A hospice referring patients to a nursing home to induce the nursing home to refer its patients to the hospice.

  A hospice providing free (or below fair market value) care to nursing home patients, for whom the nursing home is receiving Medicare payment under the skilled nursing facility benefit, with the expectation that after the patient exhausts the skilled nursing facility benefit, the patient will receive hospice services from that hospice.

  A hospice providing staff at its expense to the nursing home to perform duties that otherwise would be performed by the nursing home.

  The Office of Inspector General urges anyone who has information about a nursing home or hospice engaging in any of these possibly illegal activities to contact a regional office:

Boston (617) 565-2660

New York (212) 264-1691

Philadelphia (215) 861-4586

Atlanta (404) 562-7603

Chicago (312) 353-2740

Dallas (214) 767-8406

Los Angeles (714) 246-8302

San Francisco (415) 437-7960

  The Office of Inspector General can also be contacted at 1-800-HHS-TIPS (1-800-447-8477), Department of Health and Human Services, Office of Inspector General, P.O. Box 23489, L’Enfant Plaza Station, Washington, DC 20026-3489.

FEDERAL REGISTER, April 24, 1998