Q: What are laws and regulations governing hospice care and referrals?

A: In California, hospice care and referrals are governed by both federal and state laws and regulations, particularly in relation to the California False Claims Act (CFCA) and Medicare. Here are some key points:

1. Hospice Eligibility: To be eligible for hospice care under Medicare, a patient must be certified by a physician as having a life expectancy of six months or less if the illness runs its normal course. This certification must be made in accordance with accepted medical standards.

2. Physician Certification: The hospice must obtain written certification of terminal illness for each hospice benefit period. The certification must specify that the individual's prognosis is for a life expectancy of six months or less if the terminal illness runs its normal course.

3. Election of Hospice Care: The patient must voluntarily elect hospice care and waive the right to Medicare payment for curative treatment of the terminal illness and related conditions.

4. Plan of Care: A written plan of care must be established and maintained for each individual admitted to a hospice program, and the care provided to an individual must be in accordance with the plan.

5. False Claims: Under the CFCA, it is illegal to knowingly submit false claims to Medicare, including claims for hospice care for patients who do not meet the eligibility criteria. Violations can result in significant penalties.

6. Anti-Kickback Statute: It is illegal to offer, pay, solicit, or receive remuneration to induce or reward referrals of items or services reimbursable by a federal health care program, including Medicare. This applies to hospice referrals as well.

7. Stark Law: The Stark Law prohibits physicians from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.

These are just some of the key laws and regulations governing hospice care and referrals in California with respect to the CFCA and Medicare. Hospice providers must ensure compliance with all applicable federal and state laws and regulations.