by Countable | Updated on 7.31.18
The Inspector General of the Department of Health and Human Services (HHS) published a report today that said some hospice providers are defrauding Medicare and neglecting patients.
Hospice services are a growing Medicare benefit. In 2016, Medicare paid hospice providers $16.7 billion. A decade earlier, it was $9.2 billion.
Unlike many other healthcare providers, hospices aren't paid per service rendered. They're paid for each day a beneficiary is in their care, regardless of the quantity or quality of services provided on that day.
The report is not an indictment of hospice as a whole, noting:
“It can provide great comfort to beneficiaries and their families and other caregivers at the end of a beneficiary’s life.”
However, the report shows that sometimes, patient needs have been ignored.
For instance, it found that hospices provide significantly fewer services on the weekends than during the week. Patients’ pain levels don't diminish over the weekend, raising concerns of inadequate pain management.
The report also documents dangerous cases of fraud:
“Some fraud schemes involve paying recruiters to target beneficiaries who are not eligible for hospice care, while other schemes involve physicians falsely certifying beneficiaries.”
This can put patients at serious risk, because when they elect hospice care, they are waiving their right for Medicare payment for curative treatment. In some of the cases the report documents, patients were not even aware that they were being enrolled in hospice.
There were other forms of neglect noted in the report. For example, one hospice billed Medicare for more than two weeks of high-level care without ever visiting the patient. Instead, the hospice just called his family to ask how he was doing.
The report calls for the Centers for Medicare and Medicaid Services (CMS), which is a key player in the funding of hospice services, to increase its level of scrutiny to improve the detection of these problems.
It recommends that CMS analyze more data to ferret out scams, and that it share that information with hospice inspectors and the public.
Should CMS increase its scrutiny of hospice billing and services? Why or why not? Hit Take Action to tell your reps, then share your thoughts below.
—Sara E. Murphy
(Photo credit: iStock.com / KatarzynaBialasiewicz)
Written by Countable
Fraud will be found in many organizations/companies where there are dishonest people. Medicare has had their problems. Some hospice are owned by corporations and some are non-profit. All of them are audited. I’ve volunteered for hospice. They are a huge comfort for the dying and their families. This service should be protected and guarded from fraud.
Here, again, like the Veterans Administration, public education and Obamacare, a third party payer system does not work. As such, costs are high and quality of service is usually low since other people are spending other people’s money for something that isn’t for themselves. The Gov’t needs only to establish a set of rules and then allow the free market to supply a service at a cost consumers are will and able to afford. Allow consumers to keep and spend their own money as they see fit. It’s call the free market. This will eventually restore sanity to these corrupt, inefficient Gov’t monopolies.
I hope republicans do more to get to the bottom of the problems that were pointed out here but I fear they just don’t want the best for Americans. They sure showed they don’t care when it came to providing healthcare for ALL Americans. My experience with hospice caring for loved ones was outstanding because of the dedicated compassionate people that did all they could.
I’ve worked in healthcare for over thirty years and have some advice: never choose a for-profit hospice. Caring for the dying and answering to shareholders are completely incompatible. Visiting Nurse Association and Faith-based hospices (the Catholic Church runs many) are almost always the best choice.
Please address correcting this problem so the opponents of healthcare will not call for abandoning the hospice program. I had two relatives enrolled in hospice care. They received excellent, compassionate care. The services supported the family caregivers so well. They really were a blessing. I fear there will be a temptation to throw the baby out with the bath water. Thank you for your attention.
Million of us end up in hospice every year. We need to have rules, regulations and inspection of these facilities periodically. Congress should lead in inquiring and establishing laws to protect us. But this congress is as spineless as snail so we should vote these cucumbers out of office.
You know what would fix this? Single Payer National Insurance. Then it would be a matter of focusing on the hospitals and hospice units to improve care overall, since fraud would be an easy thing to spot in a system where users couldn't play entities off against each other, and hide details from one payer to get access to another
Medicare/Medicaid fraud/abuse is a bipartisan issue, so anyone blaming it on one party or the other is being hypocritical in a major way. Yes, more investigation needs to be done , on a continuing basis. Most of these abuses have been going on have been in progress for years, and with the full consent and oversight of both political parties. It is your entrenched lawmakers from BOTH sides, that take monetary support from the Abusers, to keep the funding and the LACK of oversight in place. Get REAL! Quit Blaming each other, as a bit of introspection is needed. THEN, Elect Lawmakers who give a damn about your welfare or your tax money. Hint! It should NOT BE the "Tax and Spend", or the "Old Guard", or the "Socialist"! Got IT?
Well there you go Privatization of care has led to fraud in every sector of the private healthcare business. Time to go to a Universal cradle to grave system. The U.S. government has researched the fact that fraud in Universal healthcare systems is greatly reduced because there is little incentive to cheat. Here is the documents. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3537805/