The audit process included reviewing a random sample of 100 claims.
SARASOTA — Federal authorities have released a report alleging Tidewell Hospice received at least $8.3 million in Medicare reimbursement for hospice services that did not comply with Medicare requirements — accusations Tidewell disputes.
A report from the U.S. Department of Health and Human Services Office of the Inspector General says the audit covered 33,024 claims for which Tidewell received Medicare reimbursement totaling $116.7 million for hospice services provided from April 2016 through March 2018. The audit process included reviewing a random sample of 100 claims. Tidewell is one of the largest and recognized hospice organizations on the west coast of Florida.
"Tidewell did not comply with Medicare requirements for 18 of the 100 claims in our sample," the report states. "For these claims, Tidewell claimed Medicare reimbursement for hospice services for which the clinical record did not support the beneficiary’s terminal illness prognosis or the level of care claimed and for services that were not eligible for Medicare reimbursement."
"These improper payments occurred because Tidewell’s policies and procedures for ensuring that claims for hospice services met Medicare requirements were not always effective," the IG report further alleges.
As a result of the audit, IG's office recommends Tidewell refund to the federal government the portion of the estimated $8.3 million in Medicare overpayments that are within a four-year claims reopening period. It also asks Tidewell to strengthen policies and procedures to ensure hospice services comply with Medicare requirements.
In a press release, Tidewell responded to the report, saying in part, "The audit reviewed 100 random claims Tidewell submitted to Medicare and the OIG identified $46,569 it determined may have been submitted in error. The OIG extended that amount to $8 million based upon a statistical extrapolation estimate of all claims Tidewell submitted during that time: a number with which Tidewell Hospice disagrees. There was no finding of fraud or deficient care as this was a payment review audit."
The statement from Tidewell also says the organization hired a palliative care and hospice medical expert to review each of the findings and submitted a written statement outlining why it believes the report is not accurate.
“Tidewell Hospice stands by our practices and our principles," says Tidewell Hospice President and CEO Jonathan Fleece in the statement. "We vehemently disagree with the medical reviewer’s opinion reflected in the OIG’s report. If errors in our seeking of Medicare reimbursement were made, we will meet our obligation and responsibilities.”
Tidewell plans to challenge the findings through the OIG's appeal process in the coming months, officials say.
Tidewell Hospice is a nonprofit that provides end-of-life and palliative care for people living with advanced illness and their families. Annually, it provides care for about 10,000 patients throughout Sarasota, Manatee, Charlotte and DeSoto counties.