Hospice Fraud: The Staggering Figures

From 2000 to 2011, Medicare has seen a 300% increase in hospice payments, a figure that has only grown since. The question remains – why is hospice so widely targeted when it comes to fraudulent schemes? Well, simply put, it seems an easy target. As evidenced by the amount of money Medicare shells out to hospice facilities, the industry is huge – and due to limited quality metrics and minimal requirements for care, critics are quick to denounce these programs as easy prey for abuse.

Strikingly, the number of for-profit hospice care facilities has doubled from 2000 to 2012; in the same span of time, Medicare spending for hospice alone skyrocketed from $2.9 billion to $15.1 billion. Of the 3,925 nationwide hospice facilities in operation in 2013, roughly 65% were for-profit; and not-so-oddly, the average length of stay in for-profits is distinctly longer than in their nonprofit counterparts.  Though Medicare has not released a figure pertaining solely to hospice fraud, it has been reported that over sixty cases were settled in 2015 alone, resulting in the recovery of hundreds of millions.

Regardless of how morally reprehensible fraud is in general, it becomes even more depraved when it involves dying patients. Not only are corrupt hospice facilities notorious for unnecessarily admitting patients, many of whom are not terminal, they often do not provide care to the standards that would be expected, if at all. In 2012, 18% of hospice patients left the facilities alive; although there are always unexpected circumstances when it comes to estimating life expectancy, a number that sizeable is a clear indication that foul play is afoot. When a patient is admitted to an end-of-life facility, they forego the opportunity to receive genuine medical treatment for their ailments, which means any wrongful admission of non-terminal patients could prevent them from receiving curative care – it’s not hard to grasp that the potential loss as a result of these schemes extends much further than money alone.

It almost seems the list of factors that lend a helping hand to fraudulent activity in hospice facilities is never-ending; to make matters worse, hospice care is a relatively easy field of work in terms of employment barriers, which allows for more people to be hired regardless of moral fiber and integrity. Of course, it would be wildly unfair to paint all hospice workers with the same brush, as the majority truly care for their patients and have entered into the field for admirable reasons. Still, with all the evidence stacked up, it certainly makes it difficult to question why so many large-scale fraud cases are found in palliative care facilities.

With all the staggering figures laid out in front of us, the need for a serious reform becomes abundantly clear.

So, what is being done to remedy this situation and advocate for those who arguably need it most? To start, for the first time since its conception in 1983, the hospice division of Medicare underwent a significant restructuring of reimbursement policies in early 2016, with the intention of lowering daily rates to the extent that it would deter any further conspiracies to commit fraud. However, experts suggest that this alone is not enough to prevent these heinous activities from occurring; because of the “sales-driven” enrollment techniques so frequently practiced by these agencies, lower reimbursement rates only drives them to intake more patients to compensate – a dangerous thought, knowing the already concerning admission techniques so commonly employed by crooked facilities. This reform took almost seven years to be implemented, and it seems unlikely we will see another one in the near future because of the rigorous process involved in restructuring such a colossal program.

At the urging of the Office of the Inspector General, Medicare also proposed more frequent audits of hospice facilities, primarily those with a history of discrepancies. This could prove useful to the cause, but with almost four thousand facilities nationwide it will surely be a large task to tackle. The development and subsequent adoption of improved quality metrics were also discussed, with the rationale that the offending agencies will sift themselves out – however, it is uncertain how successful such a system will be, as the feedback would largely come from patients on their deathbeds, many of whom are unresponsive or not in any condition to provide sound opinions.

As the sad state of affairs pertaining to this program is unveiled, it becomes obvious just how vital of a role whistleblowers play in the cessation of these vile crimes against our most vulnerable citizens. Though genuine attempts are being made to fix this clearly broken system, the importance of relaying information regarding any dishonest activity witnessed in hospice facilities is unprecedented. Under the qui tam provisions of the False Claims Act, any whistleblower who brings forward valuable information about fraudulent healthcare schemes, hospice or otherwise, is entitled to a portion of the recovered funds. We at Whistleblower Justice Network are passionate about putting an end to these heinous crimes – but we can’t do it without you.

Whistleblower Justice Network Can Help You

Whistleblower Justice Network partners with whistleblowers to bring to justice those who prioritize financial gain over moral responsibility. We assist individuals who bring forth information about fraudulent schemes in filing cases against those who knowingly risk patient lives in order to illicitly obtain government funds.

If you have meaningful information regarding hospice fraud that you believe is in violation of the False Claims Act, Whistleblower Justice Network can help. Working alongside world-class legal counsel, we will ensure you are protected to the fullest extent of the law and that you receive credit for the information you bring to the U.S. government. Partnering with whistleblowers is all we do. Visit us at www.whistleblowerjustice.net, or call us at 844-WJN-4ALL.

To see the full report published in 2015 by the Office of the Inspector General as it pertains to hospice reform, click here. 

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