No one knows how big the problem of hospice fraud is — all types of improper Medicare payments are estimated at $65 billion for 2010 — but federal investigators prosecuted more than 60 cases in the last year alone, involving hundred of millions of dollars nationwide. The system that was built to help dying patients live out their remaining days with dignity and comfort has few quality metrics to meet, no minimum requirements for how often care is provided, and low barriers to getting into the business. Critics say that can make end-of-life care seem ripe for abuse. “There’s a built-in incentive to get patients in the door,” said Claire Sylvia, a lawyer representing whistleblowers in health care fraud cases at the San Francisco offices of Phillips & Cohen LLP. For example, former Horizons Hospice chief operating officer Mary Ann Stewart, is under indictment in federal court in Pittsburgh on charges of inflating enrollment at her company’s Monroeville facility by recruiting patients who often weren’t really dying. A long-awaited reform in how Medicare pays hospice providers that went into effect in January will do little to curb such abuse, experts say. Medicare began staggering payments to better reflect the cost of care — the first reimbursement change since the benefit began in 1983.

For the article from the Pittsburgh Post-Gazette, click here.

The popularity of hospice care grew between 2004 and 2009, but that didn’t bring down Medicare costs for people dying in nursing homes, according to a new study of three quarters of a million U.S. nursing home residents. “We found that although hospice use was associated with a reduction in aggressive end-of-life care, it was also associated with a net increase of $6,761 in Medicare expenditures per decedent in the last year of life,” writes the research team, led by Dr. Pedro Gozalo of Brown University. Gozalo told Reuters Health in a telephone interview that the higher costs may be due, in part, to the fact that more patients are being enrolled in hospice earlier and those patients are more likely to be suffering from dementia or other problems that make it difficult to predict how long they will live. In 2004, the mean hospice length of stay was 72 days; by 2009 it was just under 93 days. The study did not look at Medicare costs for people who receive hospice care in their homes, and who account for the majority of hospice cases. Of all the money Medicare spends on health care, one quarter is spent in the final year of a person’s life.

For the article from Reuters, click here.