Volume 26.10
It has been reported that, as part of the ongoing fraud and abuse efforts by CMS, ownership and management control may be used to shut down operations of related hospices when a perception of inappropriate activities is conducted.
Recently, a hospice provider’s billing privileges and enrollment was revoked due to a failure to submit billings to the Medicare program for a period of six (6) months.
Subsequently, the Medicare enrollment and billing privileges were revoked for multiple hospice providers because two (2) individuals were listed in the Medicare enrollment files for these hospices (Affiliation that Poses an Undue Risk, 42 CFR §424.535(a)(19)). Some of these hospices had been operating and providing substantial services to Medicare beneficiaries for several years.
The revocation of these hospices was based on 42 CFR §424.535(a)(19). The initial revocation was based on 42 CFR §424.535(a)(8)(ii), “CMS determines that the provider or supplier has a pattern or practice of submitting claims that fail to meet Medicare requirements. In making this determination, CMS considers, as appropriate or applicable, the following:
- The percentage of submitted claims that were denied during the period under consideration.
- Whether the provider or supplier has any history of final adverse actions and the nature of any such actions.
- The type of billing non-compliance and the specific facts surrounding said non-compliance (to the extent this can be determined).
- “Any other information regarding the provider or supplier’s specific circumstances that CMS deems relevant to its determination.”
The letter of revocation for all providers must:
- State the issues or findings of fact with which you disagree and the reasons for disagreement.
- Be signed by the provider or supplier, an authorized or delegated official that has been reported within your Medicare enrollment record, or an authorized representative.
- If the authorized representative is an attorney, the attorney’s statement of authority to represent the provider or supplier is sufficient to accept this individual as the representative.
- If the authorized representative is not an attorney, the individual provider, supplier, or authorized or delegated official must file written notice of the appointment of a representative with the submission of the reconsideration request.
- Authorized or delegated officials for groups cannot sign and submit a reconsideration request on behalf of a reassigned provider/supplier without the provider/supplier submitting a signed statement authorizing that individual from the group to act on the reassigned provider’s/supplier’s behalf.
Additionally, the specific individuals will be placed on the CMS Preclusion List, dependent on the outcome of the reconsideration request or failure to submit a reconsideration request. More information is available here.
Compliance activities and initiatives, including the enrollment and financial implications of these activities, will receive significant attention at our upcoming program in Las Vegas.
REGISTRATIONS NOW BEING ACCEPTED FOR LAS VEGAS PROGRAM
The 2026 “Hospice Financial & Compliance Management Conference” is now available for registration. The two-day program is being held at Paris Las Vegas on October 1-2, 2026.
As always, this program offers the most extensive hospice financial coverage available. The integration of finance and compliance is critical to survival and success of any hospice. This year compliance and the associated financial risks are critical. Initial information and registration information is available here. Discounted room rates are available here or by calling (877) 603-4389. If you call, make certain to inform Paris Las Vegas that you are attending The Health Group program. See you in Las Vegas.