OIG COMPLIANCE PROGRAM GUIDANCE FOR NURSING FACILITIES; HOSPICE ARRANGEMENTS
Hospices must generally furnish all core hospice services themselves and not by independent contractors. However, hospices may furnish noncore services under arrangements with other providers or suppliers, including nursing facilities. When hospice patients have Medicaid coverage, the State will pay the hospice at least ninety-five percent (95%) of the State’s Medicaid daily nursing facility rate. The Hospice then accepts responsibility for the payment to the nursing facility based on the hospice’s contract with the facility. Medicare hospice reimbursement does not include room and board expenses.
The “Nursing Facility Industry Segment – Specific Compliance Program Guidance,” released in November 2024, includes compliance issues associated with hospice relationships. Hospice providers, in addition to nursing facilities, should be keenly aware of the OIG guidance provided.
Nursing facilities arrange for the provision of hospice services at the facility for a resident if the resident meets eligibility criteria and has elected the hospice benefit. Requesting payment from a hospice for the referral of the patient may subject both parties to liability under the Federal anti-kickback statute. Furthermore, under certain circumstances, a nursing facility that knowingly refer patients for hospice services who do not qualify for the hospice benefit may be liable for the submission of false claims.
The Guidance provides the following as suspect arrangements when a nursing facility:
- Refers patients to a hospice to induce the hospice to refer patients to the facility.
- Solicits or received from a hospice:
- Goods or services for free or below fair market value
- Nurses or other staff for free or below fair market value to provide services at the facility for nursing facility patients who are not patients of the hospice.
- Receives monetary payments from the hospice for:
- Room and board of a resident more than what the nursing facility would have received directly from Medicaid if the patient had not been enrolled in hospice; however, additional payments can be received for the fair market value of additional services provided to the patient that are not included in the Medicaid daily rate.
- Additional services for a resident that are not included in the Medicaid room and board payment at a rate more than fair market value.
- Any services provided to a hospice patient more than the fair market value.
The OIG Guidance is available here.
2025 HOSPICE FINANCIAL ADMINISTRATION CONFERENCE; MARK YOUR CALENDARS
The 2025 Hospice Financial Administration Conference sponsored by The Health Group, LLC is scheduled for October 16-17, 2025, in Orlando. The Program will be held at the Hilton Orlando Lake Buena Vista – Disney Springs Area. The program will include break-out sessions for certain topics that have a unique appeal to certain attendees based on prior year conference attendee comments.
The hotel is an official Walt Disney World Hotel, providing attendees with numerous benefits, including:
- Complimentary shuttle to/from Disney World theme parks,
- Disney Springs savings booklet, and
- Walking access to Disney Springs (more than 150 dining, shopping, and entertainment venues).
We look forward to seeing many of you in Orlando. Do not hesitate to contact us to make certain you receive further information at the earliest date or if you have any questions. Further information is forthcoming.