Failure by a hospice facility to use qualified personnel to perform Medicaid evaluations of patients,and extending patients’ stays beyond the appropriate designation, can result in charges of false claims
Compliance Perspective – Improper Billing
Policies/Procedures: The Compliance and Ethics Officer with the Administrator will review policies and procedures involving personnel performing Medicaid evaluations, extended stays, and the timely returning of over payments.
Training: The Compliance and Ethics Officer will ensure that staff are trained and demonstrate knowledge of acceptable Medicaid billing protocols regarding lengths of stay.
Audit:The Compliance and Ethics Officer should personally conduct an audit to determine if refunds have been made in a timely manner for any Medicaid over payments for which notification has been received.
The Kansas Attorney General recently announced that a Kansas hospice provider that is part of a larger organization with facilities in several states has agreed to pay more than $300,000 to the Kansas Medicaid program for improper billing at a facility.
The lawsuit was filed against the hospice provider under the Kansas False Claims Act to recover over payments made under the Kansas False Claims Act in 2012 and 2013. The lawsuit alleges that evaluations for 125 Medicaid beneficiaries were made by a nurse practitioner employed by the hospice who was not appropriately qualified to perform such evaluations. Also, based on certain examinations and findings regarding about 125 patients being cared for at the hospice, the State of Kansas contended that during 2012 through 2013, the hospice extended the stay for such patients beyond the appropriate duration.
When the falsity of those claims was discovered by state authorities, the hospice failed to return the improper payments within a reasonable time period after the discovery was made. Under the Kansas False Claims Act, when a provider is alerted that claims made to the state are flawed, the provider is obligated to refund the money it was paid. If the refund is not made on a timely basis, it can been forced under the False Claims Act.
The hospice agreed to the terms of the settlement and has paid $312,500 which covered the over payments and attorney fees.
