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Feds Find Fraud and Flaws in Hospice Care

by Countable | Updated on 7.31.18

The story

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.

The backdrop

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.

Possible remedy

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.

What do you think?

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)

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Written by Countable

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(42)
  • Cynthia
    08/01/2018
    ···

    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.

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  • David
    08/01/2018
    ···

    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.

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  • operaman
    08/01/2018
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    The dead never tells. Oh, and it’s ok to use opiates since it’s not for pain.

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  • Dicr
    08/01/2018
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    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.

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  • Timothy
    08/01/2018
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    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.

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  • Dave
    08/01/2018
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    Hospice providers are defrauding Medicare and neglecting patients. This does not surprise me. This is why corporations do not want any single health care program, there is big money out there for no accountability and government oversight.

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  • Marylynn
    08/01/2018
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    Now that they've found it what are they going to do about it? If they had stopped all the fraud to begin with we wouldn't have the problems we have today. It makes you wonder how many lawmakers may be party to the fraud that continues to occur.

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  • Azrael
    08/01/2018
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    Follow the money Most lead right back to Republican ownership of some sort be it outright or major stock in everything from prescriptions to nursing homes Florida is ripe for the picking

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  • Ellen
    08/01/2018
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    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.

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  • Ray
    08/01/2018
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    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.

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  • Catt
    08/01/2018
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    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

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  • Mindful
    08/01/2018
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    What kind of Care would you expect if you required Hospice Care? Then, do the right thing Now.

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  • Michael
    08/01/2018
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    Medicare fraud has been a disgrace, but never punished by jail for perpetrators-look at Governor Scott. To do this is a new low in crime under the cover of “free enterprise.” Put jail penalties all the way up and down the chain of command.

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  • Larry
    08/01/2018
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    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?

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  • Robin
    08/01/2018
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    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/

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  • Heather
    08/01/2018
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    Hospice care is vital so problems need to be remedied without cutting this service. People die.

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  • Tinee
    08/01/2018
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    All reports of Hospice negligence should be taken seriously ,investigated and negligent party held responsible. Hospice is not paid to neglect the health and wellness of the people placed in their care.

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  • Nancy
    08/01/2018
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    TAKING ADVANTAGE OF THOSE WHO ARE UNABLE TO DEFEND THEMSELVES IS DISGUSTING AND SHOULD BE ILLEGAL!

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  • Patricia
    08/01/2018
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    Do something about it. Congress needs to act as though it has equal authority to our misguided president.

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  • Lynea
    08/01/2018
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    Hospice was a huge help when my father passed away. People who give it s bad name should be jailed.

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