Hospice care has grown in popularity for people with terminal conditions who seek comfort care rather than curative treatment. But, now, more than ever, you need to choose your hospice provider carefully. Ava Kofman continues to write for Pro Publica on how profiteers have taken over hospice in the US, at huge financial cost to the Medicare program and huge risk to patients at the end of life.
As a result in significant part of Kofman’s earlier reporting, described in this Just Care post, the Centers for Medicare and Medicaid Services (CMS) conducted more hospice inspections. But, CMS continues to certify new hospices, even in California, where the state has banned new hospice licenses because of mounting hospice fraud.
It appears that CMS does not have the ability or desire to close down hospices engaging in fraud. After visits to 7,000 hospices, CMS stopped just 46 of them from billing the government for their services. The travesty: The 46 hospices were nonoperational.
CMS claims that it’s up to the states to stop the proliferation of hospices. CMS appears to be unwilling or unable to prevent even fraudulent or unneeded hospices from receiving certifications to deliver the hospice benefit to people with Medicare.
Arizona, California, Nevada and Texas have seen a huge spike in the number of its hospice providers. CMS showed marginal concern at best about fraudulent bills from these hospices and the lack of need for additional hospices in these states. CMS said it would look at their bills more closely.
California attempted to put a moratorium on new hospices in its state, with little success. Its auditors detected “a large-scale, targeted effort to defraud Medicare.” Hospice providers charged Medicare for patients who were not terminally ill and sometimes for patients who were fictitious.
Notwithstanding California’s good oversight, CMS is allowing these hospice providers to bill Medicare for their “services.” CMS claims to need “evidence of sanctions” against a hospice in order to block a hospice from the Medicare program.
In California, people enrolled in hospice fraudulently—people who are not terminally ill or who do not want hospice—are reportedly at risk of not getting needed care. Medicare covers hospice services only for patients who agree not to receive curative care for their conditions. That said, they should be able to get care for any condition unrelated to a terminal condition. Moreover, they are also always able to opt out of hospice to get curative care.
In one case, a nursing home resident with dementia was fraudulently enrolled in hospice by a doctor she did not know. Medicare paid the hospice $7,500. But, the patient lost her ability to have her pacemaker checked and to receive physical therapy. CMS is now investigating.
Here’s more from Just Care:
Leave a Reply