Colorado Improperly Claimed Some Medicaid Costs for Hospice Services Provided by Evercare Hospice and Palliative Care.

摘要

A hospice is a public agency, private organization, or a subdivision of either that is primarily engaged in providing care to terminally ill individuals. When hospice care is furnished to a Medicaid recipient residing in a nursing facility, hospice and nursing facility providers enter into a written agreement under which the hospice provider takes full responsibility for the professional management of the recipients hospice services while the nursing facility provider agrees to provide room and board. Under such an agreement, the hospice bills the State Medicaid agency for nursing facility room and board costs on behalf of a Medicaid recipient. When the State Medicaid agency reimburses the hospice for those costs, the hospice then passes those payments through to the recipients nursing facility. Previous Office of Inspector General reviews found that State Medicaid agencies, when reimbursing hospice providers for nursing facility room and board claims, did not always use correct per diem rates, reimburse payments at the required 95-percent room and board per diem rate, or reduce payments by Medicaid recipients financial contributions. The objective of this review was to determine whether the Colorado Department of Health Care Policy and Financings (State agencys) claimed costs for hospice services provided by Evercare Hospice & Palliative Care (Evercare) were in accordance with Federal and State requirements during the period October 1, 2009, through September 30, 2011.