CMS's Reliance on Accreditation Surveys Could Not Ensure the Quality of Care Provided to Medicare Hospice Beneficiaries by The Community Hospice, Inc.

CMS's reliance on accreditation surveys could not ensure the quality of hospice care that The Community Hospice, Inc. (Community), provided to Medicare beneficiaries. Specifically, we found that Community did not meet certain Federal and State requirements for criminal background checks, health assessments, professional licensing and experience, training, and performance evaluations. Of the 100 workers in our random sample, Community could not document that 51 complied with 1 or more of these requirements. On the basis of our sample results, we estimated that 194 workers were not in compliance with Federal and State requirements.

The April 2009 Community Health Accreditation Program (CHAP) accreditation survey did not find any of the types of deficiencies identified in this report; therefore, CMS's reliance on CHAP surveys could not ensure quality of care and that adequate protection was provided to Medicare beneficiaries.

To improve protection provided to Medicare hospice beneficiaries, we recommended that CMS work with CHAP and the New York State Department of Health (health department) to ensure that Community meets all Federal and State requirements for criminal background checks, health assessments, professional licensing and experience, training, and performance evaluations.

In its written comments on our draft report, the health department stated that it has no oversight authority over CHAP and that it does not survey Community, as Community has been deemed to meet Medicare conditions of participation. The health department also stated that it will continue to investigate any complaints alleged against Community and work with CMS on any remedies that are determined to appropriately address the findings in this report. CMS concurred with our recommendation.