Like many Americans, I have a story about hospice care for a loved one. When my father was dying from complications of dementia and diabetes, hospice caregivers sat with him, provided pain relief, and helped him be comfortable. They also gave my mother peace of mind that her beloved husband was receiving kind attention in his final weeks. To this day, she refers to those hospice workers as angels.

Sadly, not every family’s story is a positive one.

Some patients experience days of pain or severe anxiety because their hospices fail to provide pain management and other needed services. Some are signed up for hospice without their knowledge, including some individuals who are not terminally ill.

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The Department of Health and Human Services’ Office of Inspector General, for which I work, recently published a report examining hospice practices over a decade. It showed that hospices do not always provide the services that patients need and sometimes provide poor-quality care. We also found that patients and their families often do not receive crucial information to make informed decisions about hospice care.

We uncovered multiple abuses in our investigations:

Hospice recruiters inappropriately promised Medicare beneficiaries free housecleaning and other services that are not provided through hospice without telling them they would be signed up for the hospice benefit. That means they unknowingly gave up treatments that could cure, or at least manage, their conditions and instead received only palliative care.

In a North Texas case, nurses allegedly gave high doses of drugs such as morphine, regardless of whether patients needed it, to justify receiving the higher hospice payments. Some of these excessive dosages resulted in significant injury or death.

Or take the case of Larry Johnson’s 87-year-old mother, who had dementia. Two days before she died, he learned that she had been enrolled in hospice more than a year earlier, a decision that an individual with dementia shouldn’t make without assistance. “My mother needed basic care, but not hospice ― and especially not for a year and then some!” Johnson said in an interview with our staff.

Our investigation in her case yielded results: The owner of that hospice company received a 6-1/2-year federal prison sentence for running an elaborate, $20 million hospice scheme that signed up patients who were not dying. The hospice is permanently closed.

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The idea that hospice care could abuse and neglect patients when they are at their most vulnerable, or exploit them for unjust enrichment, is repellent.

Because taxpayers bankroll poor care and fraud through the Medicare hospice benefit, policymakers need to take immediate action to implement safeguards against fraud, waste, and abuse of this important benefit.

Growth in the use of hospice makes it even more important to take action now. The latest Medicare data show that hospice use has grown over the past decade: In 2006, Medicare paid $9.2 billion for fewer than 1 million beneficiaries in hospice care. Ten years later, it paid $16.7 billion for more than 1.4 million beneficiaries.

Quality hospice care can provide significant comfort and support to terminally ill patients and their families and caregivers. But we must take steps to prevent both the very human toll and the economic toll that hospice fraud takes.

The Inspector General’s office made recommendations to the Centers for Medicare and Medicaid Services, which runs Medicare, in seven key areas. Although CMS did not agree with a number of them, we believe they are essential for weeding out poorly performing and unscrupulous hospice providers:

  • Congress should give CMS the authority to hold poor performing hospices accountable and take swift action when warranted.
  • CMS should take steps to tie payments to patient care needs and quality of care, rather than the current approach of paying a flat rate regardless of how many services a hospice provides, which can create incentives to minimize services and seek patients with uncomplicated needs.
  • CMS should provide more information to the public, especially Medicare beneficiaries, about hospice performance so consumers can effectively compare hospice providers. CMS now provides such information for nursing homes on its Nursing Home Compare website; a similar offering for hospice on Hospice Compare would help consumers make informed choices.

Patients and their family members can help guard against fraud by carefully reviewing the summary notices they receive from Medicare detailing the services for which Medicare has been billed on their behalf and report those that were not authorized or received.

Medicare beneficiaries who elect hospice care should receive high-quality services, and hospices should act with integrity when billing government health programs. Most already do that, and assist dying patients with dignity and compassion.

We strongly urge CMS and Congress to implement our longstanding recommendations to protect patients and their families from hospice providers that are exploiting this vital service.

Joanne M. Chiedi is the principal deputy inspector general for the Department of Health and Human Services.

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  • Hospitals are billing Medicare fraudulently. Such is the case of my Medically Murdered husband at St
    Joseph Hospital in Nashua, NH and I’m sure there are manyy more using fraudulent billing practices to cover up non-consensual Hospice/Palliative care. The hospital didn’t put in claims under Hospice/Palliative care because they said he wasn’t enrolled in it. Legally he wasn’t enrolled. They ILLEGALLY, without our knowledge most definitely put him on Hospice/Palliative care AGAINST our wishes. Medical file documentation states he was put on Hospice. The Doctor that ILLEGALLY put my husband on it was paid by Medicare. The Hospice/Palliative care Doctor who overdosed him with MORPHINE and the Hospice/Palliative care Nurse Practitioner that ultimately killed him was paid by Medicare. If the Hospital filed claims under Hospice/Palliative care, they knew they wouldn’t get paid because it was ALL Illegal.
    Also a law went into effect in 2009 which states Medicare will NOT pay bills for patients with hospital acquired infections. So why did Medicare pay when my husband had a UTI, Pressure Ulcers AND SEPSIS he acquired at St. Joseph Hospital?ALL left untreated. ALL unbeknownst to me, my husband AND my family. Yes, my husband was Medically Murdered and Medicare paid for his DEATH!!! WHY???

  • Joanne: All of the instancss in this article referring to the absusive practices of some hospices is indeed true. One lagging factor is the time from complaint to action is so stretched out that folks get disheartened. Having said that, instead of punishing all for the fault of the few, it would be highly effective if a rapid response to irregular or non-compliance practices, starting with the OIG hotline would be a good deterrent to start with. Having been in the industry, we have seen the abusers keep adapting to the regulations while the ethical organizations continued to be squeezed because of their commitment to good practices and patient centered care. In one word, unleash the OIG into action and you will see a rapid drop in such behavior.

  • I have filed complaints several times as to Medicare paying for Hospice/Palliative care which we refused. My husband was put on it UN-knowingly. We were told nothing. CMS tried telling me Medicare was never billed for Hospice/Palliative care and tried to tell me my husband wasn’t on it. I sent the proof showing he was put on it and Medicare paid for it. There were no consent forms signed because we never agreed. My husband told them he wanted treatment, not death. He got no treatment. He was overdosed with Morphine and was never treated for an infection he had, or the UTI he got which turned into SEPSIS, left untreated and he died from it. Medicare Fraud? It sure is! https://inmemoryofbillknightly.blogspot.com/2017/12/why-is-medicare-paying-for-illegal.html Why is Medicare Paying For ILLEGAL Hospice/Palliative Care?

    • Filing Complaints is a waste of time. These corporations have figured out how to easily game Medicare. They also found that with their money they can easily deceive any local authorities. What we have here is weaponized greed, where under-staffing is by design, it can be profitable for providers. For example, they leave patients sitting in their own feces for days, and then charge Medicare a tidy amount to treat the resulting UTI infections. These corporations have bought the silence of Physicians, Nurses and so called “Advocates.” The Advocates and Ombudsmen work for the Institutions, not the patients.”
      It is really clever how these corrupt corporations are able to continue to bill Medicare, after thousands of complaints, deaths and adverse events. In many communities they are portrayed by the local news as “Job Creators.” They have a revolving door with the state agencies that were supposed to be monitoring them. They also manged to get ignorant journalists to portray them like the TV Show, “Better Call Saul.”
      CMS Data collecting is not set up in a way that would recognize patient dumping or injuries due to neglect. The constant nursing home Lawyer ads, give people the false idea that there is some kind of legal issue, while they only take jackpot obvious cases.
      A company called Preferred Partners LLC was able to pay off local politicians and get a friendly court in one state. Medicare refused to investigate, they also refused to investigate patent dumping by the local religious non profit hospital. This should be a criminal racket, but the first thing the new administration did was protect this industry, by keeping them from being fined. The companies did not pay the fines anyway, but we don’t let facts intrude.
      These companies even intimidate patients with the help of the advocates that were supposed to be protecting them. They operate in a Conspiracy of Silence. As long as there is a buck to be made we can not only ignore the unnecessary suffering but the costs. Covering for these criminals is normalized, and the people who complain are criminalized. Preferred Partners got out ahead of the numerous complaints and a Class Action Lawsuit, by having employees that were supposed working for the state agencies, write glowing misleading editorials in the local press. They were clearly lies, but the newspapers ran them anyway in the opinion section.
      There was also a blackout of fact based news about these criminal providers.

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