August 5, 2025

We are sending this letter to you to let you know that DHS’s Bureau of Program Integrity (BPI) has been conducting state-wide reviews of hospice services. These reviews have resulted in findings against hospice providers, which include Corrective Action Plans (CAPs) and recoupment of paid claims associated with these findings.

To help you avoid receiving such results, here is a list of some findings regularly issued by BPI:

1. Claims submitted by other providers while members were enrolled in hospice care. Make sure that you are educating your recipients that they cannot receive services from other providers while receiving hospice care. If there are questions, patients should check with the hospice provider prior to receiving services from other healthcare providers.
2. Medical records lacking or containing an untimely initial certification or recertification of terminal illness. Oral certifications were not followed by a signed certification in a timely manner.
3. Code G0299 and Code G0155 were submitted for dates not within 7 days of the recipient’s date of death.
4. Medical record did not contain documentation of all services included in the plan of care (social worker, bereavement counseling for the family, etc.).
5. Medical record did not include documentation of the Notice of Rights and Responsibilities.
6. Medical record lacked documentation of General Inpatient (GIP) level of care.

To oversee the services provided and to help hospice providers avoid receiving findings from BPI reviews, we will be conducting periodic audits of hospice medical records. If you have questions, please call our Provider Services Helpline at 1-888-991-9023 (Monday to Friday, 9 a.m. to 5 p.m.).

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans.