There’s been an increase of anti-kickback and fraud cases as regulators have zeroed in on the hospice industry. How a hospice works with referral sources can be a red flag that brings providers criminal charges in False Claims Act (FCA) cases.
Hospices with strong contracting standards have a better chance at managing risk—along with those that have compliance checks in place—partner Kathleen McDermott told Hospice News.
An outside party’s clinical review on a regular basis to assess eligibility and length of stay is a good check on the quality of hospice services provided.
“Contracts should have consistent terms that are vetted by legal and compliance professionals and maintained up to date,” said Kathleen.
“Monitoring and auditing services is key as well. Any communications that suggest a physician is being offered a compensated medical director position for referrals risks an exposure scenario.”