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Monroeville hospice part of nationwide Medicare crackdown

Justin Merriman | Tribune-Review
Cedars Community Hospice on Northern Pike in Monroeville filed for Chapter 11 bankruptcy protection on Tuesday, Jan. 15, 2013.

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A Monroeville hospice center that entered bankruptcy last week may have been caught up in a nationwide crackdown on Medicare overbilling.

Monroeville Hospice Center Inc., which does business as Cedars Community Hospice, filed for Chapter 11 bankruptcy protection in Pittsburgh on Tuesday.

Among the state-licensed center's creditors is the federal Medicare program, to which it owes $756,056 in “alleged Medicare overpayments,” according to court records.

Cedars Community Hospice did not engage in inappropriate billing, said John Silvestri, attorney for Cedars Charitable Foundation, the Monroeville nonprofit owner of the hospice center. The foundation also owns Cedars of Monroeville, a skilled nursing home founded in 1998, and Cedars Home Health Services.

“Medicare is not claiming that we did anything inconsistent with their regulations,” Silvestri said.

An audit of Cedars Community Hospice billings for the fiscal year ended Oct. 31, 2010 — the center's first full year of operation — was performed in an arbitrary manner, using an unfair method of calculating if Medicare was overbilled, Silverstri contends.

The hospice center, which gets 95 percent of its revenue from Medicare, was forced into bankruptcy after the government began holding back reimbursements for the services it provides and apply the payments to what it owes, he said.

But the hospice center plans to pay off the debt, emerge from bankruptcy protection and continue treating patients, he said.

The nursing home is operating normally, he said. The hospice center is giving patients the option to move to another center if they choose.

“This is one of those bankruptcies that's filed so that we can truly reorganize the assets we have to create the money that's necessary to pay off Medicare,” he said.

A spokesman for the Centers for Medicare and Medicaid declined to comment on the case.

While some hospice centers across the country may be pushing the envelope on billing Medicare for hospice services, many honest providers are getting caught up in the government's crackdown, said Jon Radulovic, spokesman for the National Hospice and Palliative Care Organization.

“Yes, the heat has been turned up recently,” Radulovic said.

The focus on audits is putting financial pressure on some hospice centers that have had reimbursements frozen as a result, he said.

“We understand where they're coming from,” he said, “but we want to make sure these overzealous audits aren't causing suffering.”

Hospice care, which provides specialized medical treatment at the end of life to people with terminal illnesses, is an industry that has seen explosive growth in the United States. In the past decade, the number of patients receiving hospice care more than doubled, from 700,000 in 2000 to 1.65 million in 2011, according to Radulovic's organization.

Over that same period, the number of hospice providers jumped from 3,100 to 5,300, the organization said. And for-profit companies, which in 2000 made up a minority of the hospice providers, owned 60 percent of the providers as of 2011.

The Centers for Medicare and Medicaid, which pays the bills for nine out of every 10 hospice patients, has taken notice of the growth in billings, which have jumped to $14 billion a year.

Investigators with the Centers for Medicare and Medicaid's Office of Inspector General made hospice centers a priority this year, according to the agency's 2013 work plan.

Among other things, it is focusing on nursing homes that also provide hospice services after finding in a survey that “82 percent of hospice claims for beneficiaries in nursing facilities did not meet Medicare coverage requirements.”

A California hospice center has seen its patient load drop by hundreds in the wake of the government audits, according to a report last week by Kaiser Health News, a nonprofit news service.

The nonprofit San Diego Hospice now only treats patients within a six-month window before death, resulting in a cash crunch and forcing the organization to cut 260 workers and close a 24-bed center this month, Kaiser Health News reported.

Hospice centers are paid a per-diem by Medicare, which ranges from about $120 a day to more than $800 a day, depending on the level of service needed, Radulovic said.

Abuse can take place when nursing home patients are moved into hospice care sooner than needed and higher levels of service are billed than appropriate.

Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or anixon@tribweb.com.

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