The Centers for Medicare & Medicaid Services (CMS) has expressed criticism of hospices’ underutilization of general inpatient care (GIP) while concurrently specifically targeting GIP claims for audit and medical review. This contradictory approach, while in line with CMS’s standard review tools such as Unified Program Integrity Contractors (UPIC) audits and Targeted Probe and Educate (TPE), now broadens as the Office of Inspector General (OIG) spearheads a GIP audit of its own. As seen in this episode of Husch Blackwell’s Meg Pekarske and Bryan Nowicki’s audio series, this marks a significant divergence in approach to GIP care.
As the OIG steps up involvement in hospice audits, repercussions on hospice benefits remain an area of consideration. These contrasting perspectives on GIP care are sparking queries around the future of the hospice benefit and the impact on the providers. How hospices navigate this shifting landscape could be crucial to their future operations, and in ensuring that they continue to provide top-tier care without missteps in the complicated arena of healthcare compliance.
It is crucial for hospices and other similar providers to stay abreast of the evolving landscape of regulatory oversight, particularly as it pertains to GIP claims. Legal professionals and compliance officers are advised to keep a close eye on these developments as the sector navigates this new dimension in healthcare regulatory dynamics.