Oct 25

Report Uncovers Widespread Medicare Fraud in Hospice Care


In 2013, Medicare paid $15.1 billion for hospice care for roughly 1.3 million people who were treated by 3,925 for-profit and non-profit programs throughout the country. Under federal rules, the patient or a guardian must sign an election statement accepting the hospice care, and the attending physician must certify that the patient is terminally ill and beyond a cure. But a disturbing new report by the Office of Inspector General of the Department of Health and Human Services claims that some unscrupulous hospice operators, doctors, and staff are aggressively recruiting patients for their programs in an effort to maximize profits – even when in some cases the patients shouldn’t be in hospice. The improper and fraudulent activities amount to hundreds of millions of dollars. In a third of the cases examined, the hospice election statements lacked required information or failed to adequately state the implications of the withdrawal of most medical care. Moreover, in 14 percent of the cases, the physician did not meet requirements when certifying that the beneficiary was terminally ill. Those doctors appeared to have “limited involvement” in determining that the beneficiary was appropriate for hospice care. In a number of cases, the patients outlived standard hospice care, which usually assumes a patient won’t live much longer than six months. That suggests that the patients were inappropriate candidates for the program, and as a consequence may have missed out on needed medical care.

For the article from the Financial Times, click here.