OIG report finds noncompliance with Ohio hospice licensure requirements

The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services recently released a report summarizing its review of Ohio hospice providers’ compliance with Ohio licensure requirements. The OIG concluded that the Centers for Medicare & Medicaid Services’ (CMS) reliance on Ohio licensure requirements did not provide adequate assurance that Ohio Medicaid hospice beneficiaries were receiving quality care.

The OIG’s report was based on a review of a random sample of 100 hospice claims filed within a two-year period. Of the 100 claims reviewed, 15 involved direct care provided by unqualified hospice workers. Specifically, noncompliance included failures to do, or properly document, required background checks, training, tuberculosis tests, performance evaluations, or provide written job descriptions.

Based on these findings, the OIG made the following recommendations to the Ohio Department of Medicaid (ODM) and CMS:

1. CMS should work with ODM and the Ohio Department of Health (ODH) to ensure that hospice providers meet the state licensure requirements for hospice workers.
2. CMS should consider working with ODM to modify the agency’s hospice payment conditions by implementing provisions similar to the Ohio licensure requirements for hospice workers.

According to the OIG, ODM and CMS both agreed with the recommendations. In commenting on the report, CMS said it would discuss the report findings with ODM to ensure that the requirement for background checks has been completed and that all hospice workers receive initial and ongoing training.

In response to OIG’s report, hospice providers should expect increased scrutiny from ODM and ODH to assure compliance with licensure requirements.