The U.S. Department of Health and Human Services Inspector General’s office recently issued a report finding that, while patients can generally rely on hospice care to alleviate their suffering, too many hospice providers are neglecting patients and defrauding Medicare. The report compared patient records with Medicare payment data going back as far as 2005.
Hospice services, which focus on providing pain relief and emotional support to patients in the final stages of a terminal illness, are a popular Medicare benefit. As NPR notes, Medicare paid some $16.7 billion in hospice benefits in 2016 — up almost 182 percent from a decade ago.
One way that hospice care differs from other Medicare services is that they are paid a flat daily rate “regardless of the number of services they provide and regardless of the quality of care they provide,” according to the author of the HHS Inspector General’s report.
That payment structure could result in the fewest possible number of services being provided. The report says that patient needs are sometimes ignored.
“We found that hospices provide fewer services on the weekends than during the week,” says the report’s author. “Far fewer, actually. And patients would have pain on weekends just as well as they have it on weekdays.”
In another example, a hospice billed Medicare for over two weeks of high-level care even though no provider ever visited the patient. Instead, the provider simply called the family to check on how he was doing.
Fraud can damage patients, as well. Accepting unnecessary hospice services may mean waiving Medicare coverage for curative care. “So, in effect, they’re giving up curative care. And if they don’t know they’re doing that, they could be making not the best choice for their future,” says the author.
The HHS Inspector General offered 15 recommendations for improving the situation. Primarily, it urges the Centers for Medicare and Medicaid Services (CMS) to analyze its own data to identify scams and neglect, then share that information with inspectors and with the public. Unfortunately, the CMS administrator has rejected over half of the recommendations.
If you suspect a loved one is suffering from abuse or neglect in hospice care, at a nursing home or another care facility, an attorney can help you locate evidence and develop an effective plan to stop the abuse or neglect.