Beginning July 13, 2023, the Centers for Medicare & Medicaid Services (“CMS”) will start a period of enhanced oversight for new hospices in four states, namely Arizona, California, Nevada, and Texas. This move comes in the light of multiple reports over the last year highlighting hospice fraud, waste, and abuse, issues CMS aims to tackle during this phase of increased oversight.
As stated in a recent announcement by the Medicare Learning Network (“MLN”) Fact Sheet, CMS has also identified the problem of market oversaturation, due to a significant increase in registrations with their body. Enhanced oversight is one step that is being taken to address these concerns and maintain the integrity of hospice care services.
The report raises questions on what legal professionals working with institutions affected by CMS’s decision should expect for the future. It calls for preemptived diligence and preparedness. This move is expected to bring about increased auditing and scrutiny, a surge in demands for documents, and closer monitoring of patient-related processes and interactions. Legal teams should prepare their clients to withstand such stringent regulatory measures.
The decision from CMS also reminds us of the important role compliance programs play in preventing and detecting violations in care delivery systems. Legal professionals, now, more than ever, need to help their clients to be compliant with regulations and be ready for potential government investigations into service delivery practices.
This has significant implications for both the health care industry and the entire legal landscape as heightened oversight may lead to a stricter regulatory environment, forcing organizations to ramp up their compliance efforts. In turn, it is advisable for legal professionals to better equip themselves to advise their clients effectively in this new climate.