A new report by the Office of the Inspector General (OIG) reveals that some hospices are misleading patients and defrauding Medicare. Hospices did not inform patients as required that when they elect hospice services they forego Medicare coverage of curative services. Hospices also did not engage doctors in some cases to the extent necessary to determine appropriately whether patients were terminally ill.
Medicare only covers hospice care for patients who are terminally ill, people whose doctors certify that they have six months or less to live, and who choose palliative care to keep them comfortable over care that treats their terminal condition other than hospice care. Under the hospice benefit, patients may receive a variety of services, including doctor’s care, nursing care, medical social services, medical supplies and drugs.
Most people with Medicare receive hospice care in their homes. In most instances, Medicare does not cover round-the-clock care, so patients generally need additional caregiving services from family, friends or paid caregivers. There is no set number of hours Medicare pays for.
The OIG found a high number of cases in which patients should not have been enrolled in hospice. OIG also found many instances in which hospices did not disclose to patients and their families that electing hospice care means giving up coverage for care that treats their condition.
Inappropriate billing of Medicare totalled more than $250 million for hospice general inpatient care. The OIG found that hospices billed inappropriately for this care 31 percent of the time–both when patients did not need it and when the hospices did not provide this level of care. And, the OIG found in another study that hospices typically provided fewer than five hours of care a week for the $1100 Medicare paid them.
To date some hospice owners have been convicted of fraud and sent to jail for many years for submitting false hospice claims to Medicare. The OIG report did not specify which specific hospices they had found to be overbilling Medicare or committing other fraud; today, nearly two-thirds of Medicare hospices are for-profit.
A separate Washington Post investigation found that a large number of hospice patients, particularly in for-profit hospices, were leaving hospice care alive, an indicator that something is amiss. Health may improve for a small fraction of people while receiving hospice care, but something is off when more than three in ten people are leaving hospice care alive, as the Washington Post found to be the case in Mississippi (41 percent) and Alabama (35 percent).
An increasing number of people with Medicare are opting for hospice. In 2013, there were 3,925 Medicare-certified hospice agencies, 2,411 of which were for-profit hospices. And, Medicare spent $15.1 million on hospice care for 1.3 million older adults and people with disabilities.
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