By Andrew L. Wang | Crains Chicago | June 6, 2014
A federal watchdog has determined that more than 90 percent of hospice claims sampled in an audit involved care provided by workers who didn't meet state licensing requirements.
The audit report, which was published today by the inspector general of the federal Department of Health and Human Services, sampled 120 claims from 2009 and 2010 and found that in 110 of them, hospices didn't ensure that workers had passed an initial health evaluation within 30 days of hiring. The screening involves a physical exam and a skin test for tuberculosis exposure, the audit says.
In an additional 20 claims, the hospices did not ensure that a background check had been done on workers, in accordance with state licensing requirements.
The audit estimates that the services provided by unqualified hospice workers totaled $13.4 million in Medicaid payments.
The Centers for Medicare and Medicaid Services, an arm of HHS, shares payments for hospice care for Medicaid beneficiaries with the Illinois Department of Healthcare and Family Services. The state Department of Public Health is responsible for licensing hospice workers.
“CMS' reliance on Illinois licensure requirements could not ensure quality of care and that adequate protection was provided to Medicaid hospice beneficiaries,” the audit states. “We determined that in most cases hospices did not meet state hospice licensure requirements related to hospice workers.”
The report recommends that CMS work with both state agencies to ensure that workers meet licensing requirements, and consider working with the state on changing payment conditions. It was unclear if there were other penalties.
The audit does not name specific hospice providers.
Hospices provide palliative care for terminally ill patients. Services include nursing care, home health aide services and physical care. Medicaid also covers the cost of room and board for beneficiaries in a facility.
Among the other findings:
A federal watchdog has determined that more than 90 percent of hospice claims sampled in an audit involved care provided by workers who didn't meet state licensing requirements.
The audit report, which was published today by the inspector general of the federal Department of Health and Human Services, sampled 120 claims from 2009 and 2010 and found that in 110 of them, hospices didn't ensure that workers had passed an initial health evaluation within 30 days of hiring. The screening involves a physical exam and a skin test for tuberculosis exposure, the audit says.
In an additional 20 claims, the hospices did not ensure that a background check had been done on workers, in accordance with state licensing requirements.
The audit estimates that the services provided by unqualified hospice workers totaled $13.4 million in Medicaid payments.
The Centers for Medicare and Medicaid Services, an arm of HHS, shares payments for hospice care for Medicaid beneficiaries with the Illinois Department of Healthcare and Family Services. The state Department of Public Health is responsible for licensing hospice workers.
“CMS' reliance on Illinois licensure requirements could not ensure quality of care and that adequate protection was provided to Medicaid hospice beneficiaries,” the audit states. “We determined that in most cases hospices did not meet state hospice licensure requirements related to hospice workers.”
The report recommends that CMS work with both state agencies to ensure that workers meet licensing requirements, and consider working with the state on changing payment conditions. It was unclear if there were other penalties.
The audit does not name specific hospice providers.
Hospices provide palliative care for terminally ill patients. Services include nursing care, home health aide services and physical care. Medicaid also covers the cost of room and board for beneficiaries in a facility.
Among the other findings:
- • In 17 claims, training requirements were not met for hospice workers. Licensure requires that they go through an orientation upon hire and receive training on the job, but hospice providers did not always document that the training occurred.
- • In 12 claims, hospices didn't maintain all required personnel information for workers. Each worker file must contain information such as home address, Social Security number and past employment history, among other basic details.
- • In five claims, hospices did not document workers' job responsibilities.
- • In one claim, a hospice could not provide evidence of a worker's state certification. In another claim, a worker didn't have certification in Illinois but was certified in Iowa.
http://www.chicagobusiness.com/article/20140606/NEWS03/140609859/feds-ding-illinois-agencies-on-hospice-care?utm_source=NEWS03&utm_medium=rss&utm_campaign=chicagobusiness
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