Hospice Resource Center

• Social Security Act
• Electronic Code of Federal Regulations
• Rule Commentary from the Federal Register - 2020s
• Hospice Wage Index Rules
  • FY 2023 Hospice Wage Index Rule (Final) (September 29, 2022)
    Keywords: Hospice Quality Reporting Program; Hospice Outcomes and Patient Evaluation; health equity; survey and enforcement procedures
  • FY 2022 Hospice Wage Index Rule (Final) (August 4, 2021)
    Keywords: election statement addendum; COVID-19 waivers; Hospice Quality Reporting Program
  • FY 2021 Hospice Wage Index Rule (Final) (August 4, 2020)
    Keywords: commentary about election statement and addendum commentary
• Other Rule Commentary
  • COVID-19 Interim Final Rule (May 8, 2020)
    Keywords: audio-only telephone evaluation and management services
  • COVID-19 Interim Final Rule (April 6, 2020)
    Keywords: virtual visits for routine home care; telehealth for face-to-face encounters
• Rule Commentary from the Federal Register - 2010s
• Hospice Wage Index Rules
  • FY 2020 Hospice Wage Index Rule (Final) (August 6, 2019)
  • Keywords: election statement and addendum; rate rebasing
  • FY 2019 Hospice Wage Index Rule (Final) (August 6, 2018)
    Keywords: physician assistants included as attending physicians
  • FY 2018 Hospice Wage Index Rule (Final) (August 4, 2017)
    Keywords: commentary about clinical information sources for certification
  • FY 2017 Hospice Wage Index Rule (Final) (August 5, 2016)
    Keywords: commentary about Medicare Care Choices Model
  • FY 2016 Hospice Wage Index Rule (Final) (August 6, 2015)
    Keywords: SIA payments; two rates for RHC; federal FY for inpatient and aggregate cap years; commentary on diagnosis reporting on claims
  • FY 2015 Hospice Wage Index Rule (Final) (August 22, 2014)
    Keywords: attending physician identified on election statement; change of attending physician; notice of election filing; notice of termination/revocation filing; expedited self-reporting of aggregate cap determinations; hospice quality reporting program; commentary on Medicare hospice benefit coverage, clinical eligibility determinations, and coordination of Part D drug coverage
  • FY 2014 Hospice Wage Index Rule (Final) (August 7, 2013)
    Keywords: commentary on diagnosis reporting on claims; commentary on Hospice Item Set and CAHPS® survey data collection
  • FY 2013 Hospice Wage Index Rule (Final) (July 27, 2012)
    Keywords: commentary on diagnosis reporting on claims
  • FY 2012 Hospice Wage Index Rule (Final) (August 4, 2011)
    Keywords: aggregate cap calculation methodologies; face-to-face attestation content for nurse practitioners and non-certifying hospice physicians; timeframe for face-to-face encounters; commentary on use of LCDs, definition of hospice “employee,” and hospice quality reporting program
  • FY 2011 Hospice Wage Index Rule (Final) (July 22, 2010)
• Other Rule Commentary
  • Medicare Affiliations Rule (September 10, 2019)
    Keywords: Medicare requirements for disclosure of affiliations with other providers
  • 60-Day Overpayment Rule (February 12, 2016)
    Keywords: reporting and returning Medicare overpayments
  • Requirements for Long-Term Care Facilities; Hospice Services Rule (June 27, 2013)
    Keywords: requirements for facilities that contract for hospice services
  • Hospice Quality Reporting Requirements  Rule (November 8, 2012)
    Keywords: commentary on hospice quality reporting program
  • Medicare Enrollment Requirements Rule (Final) (February 2, 2011)
    Keywords: provider enrollment, screening, and termination from Medicare and Medicaid; recovery of overpayments and payment suspension
  • Face-to-Face Requirements Rule (Final) (November 17, 2010)
    Keywords: face-to-face encounter and attestation requirement; requirement for certifications to specify benefit period dates
• Rule Commentary from the Federal Register - 2000s
• Hospice Wage Index Rules
  • FY 2010 Hospice Wage Index Rule (Final) (August 6, 2009)
    Keywords: physician narrative requirement; clarification on computing inpatient cap; commentary on aggregate cap calculation
  • FY 2009 Hospice Wage Index Rule (Final) (August 8, 2008)
  • FY 2008 Hospice Wage Index Rule (Final) (August 31, 2007)
  • FY 2007 Hospice Wage Index Rule (Final) (September 1, 2006)
  • FY 2006 Hospice Wage Index Rule (Final) (August 4, 2005)
  • FY 2005 Hospice Wage Index Rule (Final) (August 27, 2004)
  • FY 2004 Hospice Wage Index Rule (Final) (September 30, 2003)
  • FY 2003 Hospice Wage Index Rule (Final) (August 30, 2002)
  • FY 2002 Hospice Wage Index Rule (Final) (September 27, 2001)
  • FY 2001 Hospice Wage Index Rule (Final) (October 6, 2000)
• Other Rule Commentary
  • Hospice Conditions of Participation Rule (Final) (June 5, 2008)
    Keywords: comprehensive revisions to Medicare hospice conditions of participation, including requirements for facility and hospital arrangements
  • Hospice Certification Rule (Final) (November 22, 2005)
  • Pre-Hospice Consultation Rule (Final) (November 15, 2004)
• Rule Commentary from the Federal Register - 1990s
  • Changes to Home Health Aide Section Rule (Final) (December 20, 1994)
  • Hospice Benefit Extension Rule (Final) (August 12, 1992)*
  • Hospice Certification Rule (Final) (December 11, 1990)*
• Rule Commentary from the Federal Register - 1980s
  • Original Hospice Regulations Rule (Final) (December 16, 1983)*
• The following is a selection of the key CMS manual chapters relating to hospices:
  • State Operations Manual - Chapter 2
  • State Operations Manual - Appendix M
  • Medicare Benefit Policy Manual - Chapter 9
  • Medicare Claims Processing Manual - Chapter 11
  • Targeted Probe, Educate and Pilot (Sept. 15, 2017)

* Used with permission from HeinOnline.

• Compliance guidance
  • Evaluation of Corporate Compliance Programs (June 2020)
  • Evaluation of Corporate Compliance Programs (April 2019)
  • Evaluation of Corporate Compliance Program (2017)
  • Measuring Compliance Program Effectiveness: A Resource Guide (January 17, 2017)
  • Individual Accountability for Corporate Wrongdoing (“Yates Memo”) (September 9, 2015)
  • Practical Guidance for Health Care Governing Boards on Compliance Oversight (April 20, 2015)
  • Corporate Responsibility and Corporate Compliance (2013)
  • OIG Compliance Guidance for Hospices (October 5, 1999)
• Fraud alerts
  • Physician Compensation Arrangements May Result in Significant Liability (June 9, 2015)
  • Fraud and Abuse in Nursing Home Arrangements with Hospices (March 1998)
• Work plans
  • Review of Hospices: Compliance with Medicare Requirements (2021)
  • Medicare Payments for Chronic Care Management (2021)
  • Joint Work With State Agencies (October 2020)
  • Medicare Hospital Payments for Claims Involving the Acute- and Post-Acute-Care Transfer Policies (March 2020)
  • Review of Hospice Inpatient and Aggregate Cap Calculations (October 2019)
  • Medicare Payments Made Outside of the Hospice Benefit (June 2018)
  • Hospice Excerpts (2017)
  • Hospice Excerpts (2016)
  • Hospice Excerpts (2015)
  • Hospice Excerpts (2014)
  • Hospice Excerpts (2013)
  • Hospice Excerpts (2012)
  • Hospice Excerpts (2011)
  • Hospice Excerpts (2010)
  • Hospice Excerpts (2009)
  • Hospice Excerpts (2008)
  • Hospice Excerpts (2007)
  • Hospice Excerpts (2006)
  • Hospice Excerpts (2005)
  • Hospice Excerpts (2004)
  • Hospice Excerpts (2003)
  • Hospice Excerpts (2002)
  • Hospice Excerpts (2001)
  • Hospice Excerpts (2000)
  • Hospice Excerpts (1999)
  • Hospice Excerpts (1998)
  • Hospice Excerpts (1997)
• Reports
  • Registered Nurses Did Not Always Visit Medicare Beneficiaries’ Homes at Least Once Every 14 Days To Assess the Quality of Care and Services Provided by Hospice Aides (November 2019)
  • Medicare Part D is Still Paying Millions for Drugs Already Paid for Under the Part A Hospice Benefit (August 2019)
  • Safeguards Must Be Strengthened To Protect Medicare Hospice Beneficiaries From Harm (July 2019)
  • Hospice Deficiencies Pose Risks to Medicare Beneficiaries (July 2019)
  • Semiannual Report to Congress (April 1 - September 30, 2018)
  • Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity: An OIG Portfolio (July 2018)
  • Enhancements Needed in the Tracking and Collection of Medicare Overpayments Identified by ZPICs and PSCs (September 2017)
  • Hospices Should Improve Their Election Statements and Certifications of Terminal Illness (September 2016)
  • Hospice Inappropriately Billed Medicare Over $250 Million for General Inpatient Care (2016 report)
  • CMS’s Reliance on Puerto Rico’s Certification Surveys Could Not Ensure the Quality of Care Provided to Medicare Hospice Beneficiaries by Servisios Suplementrios de Salud, Inc. (2015 report)
  • New Jersey Claimed Medicaid Hospice Services That Were Not In Compliance With Federal and State Requirements (2015 report)
  • Ohio Did Not Always Properly Claim Medicaid Reimbursement for Hospice Claims (2014 report)
  • Medicare Hospice: Use of General Inpatient Care (2013 report)
  • Illinois Did Not Always Properly Claim Medicaid Reimbursement for Hospice Claims (2013 report)
  • Medicare Hospices that Focus on Nursing Facility Residents (2011 report)
  • Hospice Beneficiaries’ Use of Respite Care (2008 report)
  • Samaritan Care, Inc. (1998 report)
  • Medicare Hospice Beneficiaries: Services and Eligibility (1998 report)
  • Hospice Patients in Nursing Homes (1997 report)
  • Hospice and Nursing Home Contractual Relationships (1997 report)
  • Enhanced Controls Needed to Assure Validity of Medicare Hospice Enrollments (1997 report)
  • Hospice of the Florida Suncoast, Inc. (1996 report)
  • Hospice of Lake & Sumter (1996 report)
  • Operation Restore Trust Activities (1995 report)
• Bulletins
  • Publication of the Medicare Advisory Bulletin on Hospice Benefits (November 1995)
• Advisory Opinions
  • OIG Advisory Opinion No. 16-08 “ Advisory Opinion on a Hospice Making Supplemental Payment to Nursing Facilities in Which Hospice’s Dually Eligible Patients Reside When the Nursing Facilities—Instead of the Hospice—Receive Payment for their Patients’ Room and Board Expenses” (July 2016)
  • OIG Advisory Opinion No. 12-17 “Advisory Opinion on a Hospice Establishing Volunteer Program to Patients Who do not Qualify for Hospice Care” (November 2012)
  • OIG Advisory Opinion No. 04-18 “Advisory Opinion on a Series of Cash Donations to a Nonprofit Hospice from a Charitable Foundation Affiliated with a Health System (December 2004)
  • Advisory Opinion Regarding Nursing Home Room and Board (2001)

• CMS - Review Contractor Directory - Interactive Map
• CMS - Local Coverage Determinations (LCDs) by Contractor Index
• CMS - Medicare Administrator Contractor Jurisdictions

• Anti-Kickback Statute - 42 U.S.C. § 1320a-7b
• The following is a selection of commonly used safe harbors to the federal Anti-Kickback Statute:
  • gpo.gov - Entire Text of Safe Harbors
  • Personal Services and Management Contracts Safe Harbor (as of 2.12.21)
  • Employees Safe Harbor (as of 2.12.21)
  • Space Rental Safe Harbor (as of 2.12.21)
  • Investment Interests Safe Harbor (including small business investment interests) (as of 2.12.21)
  • Equipment Rental Safe Harbor (as of 2.12.21)
  • Discounts Safe Harbor (as of 2.12.21)

• Settlements
  • $3.2M FCA settlement: general inpatient (GIP), billing. Hope Hospice (July 2020)
  • $1.75M settlement: admission practices, failure to supervise, billing. STG Healthcare of Atlanta, Inc., Paschal “Pat” Gilley, and Mathew Gilley (March 2020)
  • $5M FCA settlement: definitions of medical necessity, billing, failure to document. Haven Hospice (December 2017)
  • $75M FCA settlement: eligibility, continuous care, billing, kickback. Chemed Corporation, Vitas Hospice Services LLC (October 2017)
  • $1.9M/39 month federal prison sentence: conspiracy charges for physician, billing. Dr. Nathaniel Brown (August 2017)
  • $19.5M FCA settlement: definitions of medical necessity, kickbacks, certification. Foundations Health Solutions Inc., Olympia Therapy Inc., and Tridia Hospice Care Inc., Brian Colleran, and Daniel Parker (July 2017)
  • $8M FCA settlement: fabricated claims. Home Care Hospice, Inc. (July 2017)
  • $2.4M FCA settlement: kickbacks, Hospice. Compassionate Care Hospice Group, Inc. (July 2017)
  • $53.6M FCA settlement: definitions of medical necessity, billing, Resource Utilization Group (RUG) level, failure to meet standard of care. Genesis Healthcare Inc., Skilled Healthcare Group Inc., Creekside Hospice II LLC, Hallmark Rehabilitation GP LLC, Healthcare Group Inc., and SunDance Rehabilitation Agency Inc. (June 2017)
  • $12M FCA settlement: anti-kickback statute (AKS). International Tutoring Services, LLC, Phoenix Hospice, LP, Hospice Plus, L.P., and Curo Health Services, LLC (April 2017)
  • $18M FCA settlement: definitions of terminal illness, eligibility. Evercare Hospice and Palliative Care (July 2016)
  • $1M FCA settlement: terminal illness prognosis. Iowa Hospice, LLC (December 2015)
  • $3M FCA settlement: length of stay (LOS), failure to document. Hospice of Citrus County (November 2015)
  • $2.2M FCA settlement; admissions, referrals, kickback. Serenity Hospice and Palliative Care (October 2015)
  • $3M FCA settlement: definitions of terminal illness, failure to train. Guardian Hospice of Georgia, LLC and AccentCare, Inc. (October 2015)
  • $5.86M FCA settlement: continuous care, billing. St. Joseph Hospice Entities (September 2015) 
• Key cases
  • Winter ex rel. United States v. Gardens Reg’l Hosp. & Med. Ctr., Inc. (9th Cir., March 23, 2020)
  • United States v. Care Alternatives (3d Cir., March 4, 2020)
  • United States v. AseraCare, Inc. (11th Cir., Sept. 9, 2019)
  • United States v. Paulus (6th Cir., June 25, 2018)
  • United States ex rel. Polukoff v. St. Mark’s Hosp. (10th Cir., July 9, 2018)
  • Ruckh v. CMC II LLC et al., (M.D. Fla. Jan. 11, 2018)
  • U.S. v. LifePath Hospice, Inc. et al., (M.D. Fla. Sept. 22, 2016)
  • Universal Health Services v. U.S. ex rel. Escobar, (U.S. Supreme Court, June 20, 2016)
  • U.S. ex rel. Wall v. Vista Hospice Care, (N.D. Tex. June 20, 2016)

• MedPAC and GAO reports
  • 2021 Hospice Services
  • 2020 Medicare payment policy
  • 2019 Medicare Hospice Services Payment Basics
  • 2019 Medicare payment policy
  • 2018 Medicare payment policy
  • 2019 GAO Report – Medicare Hospice Care: Opportunities Exist to Strengthen CMS Oversight of Hospice Providers
  • 2017 Medicare payment policy 
  • 2016 Medicare payment policy
  • 2015 report to MedPAC by Direct Research, LLC - Spending in the Last Year of Life and the Impact of Hospice on Medicare Outlays
  • 2015 Medicare payment policy
  • 2014 Medicare payment policy
  • 2013 Medicare payment policy
  • 2013 Medicare and the Healthcare Delivery System
  • 2012 Medicare payment policy
  • 2011 Medicare payment policy
  • 2010 Medicare payment policy
  • 2009 Medicare payment policy
  • 2008 Reforming the Delivery System
  • 2006 Increasing the Value of Medicare
  • 2004 Hospice Care in the Medicare Recent Trends and a Review of the Issues
  • 2003 Medicare payment policy
  • 2002 Medicare payment policy
  • 2002 Medicare Beneficiaries' Access to Hospice
• Abt reports
  • 2016 Medicare Hospice Payment Reform: A Review of the Literature
  • 2015 Medicare Hospice Payment Reform: Analysis of How the Medicare Hospice Benefit is Used
  • 2014 Update to Hospice Payment Reform Research
  • 2014 Abt Medicare Hospice Payment Reform: Analyses to Support Payment Reform
  • 2014 Abt Medicare Hospice Payment Reform: A Review of the Literature
  • 2014 Presentation at National Hospice and Palliative Care Organization’s (NHPCO) 29th Management and Leadership Conference
  • 2013 Abt Medicare Hospice Payment Reform: Hospice Study Technical Report
  • 2013 Abt Medicare Hospice Payment Reform: A Review of the Literature

• Hospice Insights: The Law and Beyond
• COVID-19 How-To Series
• Governance Series
• Hospice and the False Claims Act Series
• Hospice Audit Series
• Hospice Innovators
• Hospice Labor and Employment Trends
• Hospice Privacy Series
• Perspectives on End of Life Care
• Strategic Restructuring for the Future

• Overpayment Repayment Timeline under 60 Day Repayment Rule
• Beneficiary Inducement Prohibition Overview
• Checklist of HIPAA Breach Action Steps
• Federal Anti-Kickback Statute Overview
• Federal Anti-Kickback Statute Investment Interest Safe Harbor Overview
• Federal Anti-Kickback Statute Personal Services and Management Contract Safe Harbor Overview
• Federal False Claims Act Overview
• Medicare Hospice Regulatory Conditions of Payment
• Palliative Care and Beyond: Key Legal Considerations for Hospices Pursuing Upstream Revenue and Service Opportunities
• Stark Law Overview
• Success Through Collaboration: Overview of Network Models for Hospices
• Summary of Key Allegations in Hospice False Claims Act Cases
• Telehealth Flowchart for Billable Hospice Physician and Nurse Practitioner Services During the COVID-19 Pandemic