Hospice fraud is an exceptionally well-obscured facet of healthcare fraud, as the majority of patients under the care of hospice facilities are elderly, terminal, or otherwise incapacitated. This, coupled with the low quality metrics required of hospice care by government healthcare standards, lends to the criticism that these facilities are ripe for abuse.
Under Medicare standards, a patient is only eligible to receive hospice care if they are diagnosed with a terminal illness with a life expectancy of less than six months, and must submit in writing that they waive any form of curative care in their admittance to hospice. However, with these being the only standards for reimbursement, this subset of government healthcare is often defrauded.
Examples of hospice fraud include, but are not limited to:
- Admitting non-terminal patients for hospice care, and thus depriving them of curative medical treatment
- Forging documents that certify patient consent to receive hospice care
- Filing claims for services that were not rendered
- Falsifying medical records that allow the facility to bill for a higher reimbursement rate
- Offering sales commissions to facility employees dependent on a patient’s length of stay
- Billing multiple times for one procedure or treatment, regardless of whether it was actually provided
- Entering into unlawful relationships with referral sources, oftentimes resulting in the exchange of gifts, cash, or free services
The uncovering of hospice fraud schemes often arise from whistleblowers, many times directly from employees of hospice facilities who become aware of the dishonest practices and choose to do the right thing. Not only does hospice care take advantage of those at the end of their lives, but it consequently puts a heavy financial burden on the Medicare program and the taxpayers who support it.
Whistleblower Justice Network has partnered with many whistleblowers in filing healthcare fraud cases; having been whistleblowers ourselves, we are able to offer a unique perspective which allows us to advise others through the process and choose the most appropriate legal counsel for your specific case.
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