A Clearwater-based hospice provider received $47.4 million in Medicare reimbursements that did not comply with requirements over a two-year period, according to a federal audit released Monday.
The inspector general of the U.S. Department of Health and Human Services recommended that Suncoast Hospice — which operates three hospice care centers — refund to the federal government the portion of the $47,363,971 that is within a four-year “claims reopening period.”
Also, the inspector general’s office recommended that the hospice, formally known as The Hospice of the Florida Suncoast, Inc., strengthen policies and procedures to ensure that services comply with Medicare requirements.
According to the audit, the hospice provided services to about 12,400 beneficiaries and received Medicare reimbursement of almost $149 million from July 1, 2015, to June 30, 2017. Investigators reviewed a sample of 100 claims and concluded that 51 complied with requirements but 49 did not.
Of those 49 claims, clinical records did not support patients’ terminal prognosis in 30 cases. Also, in 20 claims, the clinical record did not support the level of care claimed for Medicare reimbursement.
In two cases, Suncoast claimed “service intensity add on” payment for services that were not provided, according to the report. In three claims, more than one error was found. Medicare provides health insurance coverage to people ages 65 and older, people with disabilities and people with end-stage renal disease.
To qualify for Medicare hospice care, patients must be eligible for what is known as Medicare Part A and be certified by a physician as being terminally ill or having a life expectancy of six months or less. Suncoast Hospice disputed the audit’s findings.
“Specifically, Suncoast disagreed with all but two of the 49 sample claims questioned in our draft report,” the audit said. “Accordingly, Suncoast does not believe it was overpaid for hospice services except for the two claims it agreed were in error.”
Suncoast Hospice is part of the non-profit Empath Health. It has two satellite offices along with three inpatient units in Pinellas County.