Medicare Hospice Cap Challenged by Texas Lawsuit

Last week, a lawsuit was filed in the Northern District of Texas federal court, challenging the validity of the aggregate annual cap for hospice reimbursement.

Medicare provides reimbursement for hospice services rendered on a per beneficiary, per diem basis, subject to an aggregate annual cap. This cap is based upon the product of a per-beneficiary amount and the number of Medicare beneficiaries in a hospice program during a given accounting year. Any provider whose Medicare revenues exceed the cap are subject to demands for repayment of the difference from Medicare.

In the case of Dallas Nursing Home LLC d/b/a Golden Acres v. Kathleen Sebelius, Secretary of United States Department of Health and Human Services, Golden Acres Nursing Home asks the court to rule that “the hospice cap regulation is invalid.” In its complaint, Golden Acres Nursing Home alleges that, in calculating the cap, Medicare has failed to follow the Congressional mandate to allocate the cap proportionally across years of care, which subjects hospice providers to improper repayment demands.

For more information, please contact The Health Law Partners, P.C. at (248) 996-8510.