In July 2023, the Centers for Medicare and Medicaid Services (CMS) announced increased efforts to combat hospice fraud and abuse, focusing on oversight of hospice ownership and physician medical directors who certify patients for hospice services. Vulnerable hospice patients have led CMS and the Department of Justice (DOJ) to prioritize their protection, resulting in Corporate Integrity Agreements and settlements with hospice agencies to avoid exclusion from federal healthcare programs.

Notable cases involving kickbacks to physicians for certifying unqualified patients have drawn attention, while Medicare’s 2024 Hospice Proposed Rule aims to enhance program integrity by requiring Medicare-enrolled physicians to order or certify hospice services. Establishing the Fair Market Value of hospice medical director compensation is crucial for compliance and defense against allegations, with market data and adherence to regulations playing key roles. Market surveys and analysis can help determine fair compensation rates and ensure legality, aiding hospice agencies in avoiding fraud and abuse investigations.

Nicholas A. Newsad, MHSA works in the Advisory Services Group at LBMC. He can be contacted at nick.newsad@lbmc.com or 615-309-2489.