Good evening Hospice community,
The HHS-OIG just released a new audit
report (posted 6/23/2026) examining Medicare payments for new hospice enrollees in FY 2021. OIG reviewed whether CMS made appropriate hospice payments for new enrollees who did not have an emergency room or inpatient claim in the 18 months before starting hospice care. OIG found that documentation for 45 of 100 sampled initial certification periods did not meet Medicare requirements, resulting in unallowable payments. Specifically, OIG identified insufficient clinical support for terminal illness (21/45 claims) and missing eligibility documentation (7/45 claims). It is estimated that Medicare could have saved $255.1 million if Medicare Administrative Contractors had eligibility review procedures for these high‑risk cases. Please reach out with any comments, questions or concerns!
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Betta Deblasio
Analyst, Policy & Regulatory Affairs
National Alliance for Care at Home
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