Hospice Fraud Targets the Weak

Just like other types of Medicare fraud, hospice fraud is growing. Hospice is a program that provides care and support for terminally ill patients and their caregivers. According to the U.S. Department of Health and Human Services (DHHS), in 2013, 1.3 million Medicare beneficiaries received hospice care. Because Medicare pays generous hospice benefits for family support services, necessary medical services, medications and durable medical equipment, the system is ripe for fraud by unscrupulous individuals and companies. Fraudsters target these vulnerable individuals because it is difficult for a grieving family to even review their loved ones’ Medicare statements, much less identify fraud.

Medicare hospice benefits are available to Medicare Part A beneficiaries who have been certified by a doctor to be terminally ill with a life expectancy of six months or less (if the illness runs its normal course) and the patient has agreed to accept medical services only for pain relief and symptom control (also known as palliative care) and to stop treatments intended to cure the illness.

In 2015, the daily base rate paid by Medicare to hospice providers varied from $159.34 to $708.77 depending on the level and location of services (home care or in-patient care). Hospice care can include doctor and nursing services; prescription medications for pain and symptom relief; physical and occupational therapy; dietary counseling; grief and loss counseling for family members; and medical equipment, such as wheelchairs and walkers.

The incidents of hospice fraud are growing. The most common fraud involves falsifying records and providing hospice benefits to individuals who are not terminally ill. The Office of the Inspector General (OIG) for the DHHS reports that other common types of hospice fraud are:

• Paying illegal kickbacks for the referral of hospice patients;
• Billing for inadequate or incomplete services;
• Billing for a higher level of care than was actually provided;
• Falsifying records to re-certify that beneficiaries are eligible for hospice care when, in fact, their conditions have improved and they no longer need hospice care (in one extreme case cited by the OIG, the patient was terminally ill for 9 years, but continued to receive hospice care); and,
• Ordering unnecessary medical equipment for patients (e.g., billing for a wheelchair for an ambulatory patient).

As our population ages, more and more Medicare beneficiaries will be seeking hospice care. With the increase in the number of potential “targets,” Medicare fraud will only continue to grow. Caregivers dealing with a loved one’s terminal illness can get free help reviewing their loved one’s medical bills and Medicare statements from the Senior Medicare Patrol (SMP). A list of SMP offices is available here.

If you have witnessed Medicare fraud by a hospice provider, contact the fraud whistleblower lawyers at Rabin Kammerer Johnson for a free consultation at 877-915-4040.