A preliminary investigation by HHS' inspector general's office estimates that $19.7 million was improperly paid to 37 hospice providers for ineligible Medicare patients in Puerto Rico from 1991 to 1994.
The inspector general's office and the FBI have been working on several similar hospice cases in the United States, said Robert Wolin, an attorney with Baker & Hostetler in Houston.
In Puerto Rico, a U.S. territory, the inspector general's office reviewed 2,845 beneficiaries and found 1,634, or 57%, were ineligible for the Medicare hospice program because they weren't terminally ill.
Under Medicare rules, a physician must certify the patient is terminally ill, which is defined as having a life expectancy of six months or less.
The inspector general has recommended HCFA instruct the peer review organization for Puerto Rico, Wisconsin-based United Government Services, to collect the improper payments from the hospices and to beef up its claims-monitoring system.