A recent OIG report examined whether hospices are meeting all requirements associated with the election statement that Medicare beneficiaries sign when they choose hospice care, and whether physicians are meeting all requirements for certifying Medicare beneficiaries for hospice care. According to the OIG, more than one third of hospice general inpatient (GIP) stays in 2012 lacked required information or had “other vulnerabilities” (e.g., the patient’s revocation or discharge information was inaccurate or unclear). Moreover, in 14 percent of GIP stays, the physician not only failed to meet all associated requirements, such as composing a narrative when certifying the patient’s terminal illness, but also “appeared to have limited involvement in determining that the beneficiary was appropriate for hospice care.”

To strengthen safeguards for Medicare beneficiaries, the OIG recommends that CMS: (1) develop and disseminate model text for hospice election statements; (2) instruct surveyors to strengthen their review of election statements and certifications of terminal illness; (3) educate hospices about these topics; and (4) provide guidance to hospices clarifying the effects of revocation and discharge on the beneficiary. CMS generally concurred with these recommendations.