HOSPICE CARE: GOVERNMENT AUDITS MEDICARE REIMBURSEMENTS
"Concerned that some hospices may be taking advantage of theThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
government, the Department of Health and Human Services is trying
to recover $83 million in payments from a dozen hospices around
the country," according to U.S. NEWS & WORLD REPORT. Hospice
benefits paid by Medicare can only cover the last six months of
life, and HHS has notified the twelve hospices that they received
improper funds (Shapiro, 3/24 issue). LOS ANGELES TIMES reports
that the "get-tough policy is part of the government's Operation
Restore Trust" (see AHL 5/14/96), which works to eliminate fraud,
abuse and waste in the Medicare program. The program is
operational in California, Illinois, Texas, Florida and New York;
the federal government has said it will expand the program to all
50 states (Rosenblatt, 3/15).
ANSWERS: Medicare began reimbursing for hospice care in
1983 and has "fueled a fourfold increase in patients served."
The program "now pays for two-thirds of all hospice care, a total
of nearly $2 billion a year." U.S. NEWS reports that since the
government began auditing hospices in 1991, the "number of long-
term hospice patients has started to decline." The government,
according to U.S. NEWS, believes "this is a sign that hospices
are being more careful." Hospice supporters, however, said they
are "being penalized for their effectiveness," as the terminally-
ill patients they are charged with caring for "live longer than
expected because of the quality of care." Hospice advocates
contend that "Medicare's penny-pinching may wind up suffocating
the hospice movement -- and costing the system more in the long
run." While hospice is estimated to save Medicare $1.52 for
every dollar spent in the last year of life, "the savings are
less certain after six months in hospice care." While 15% of
patients live longer than the government's allotted six months of
eligibility, 29% die within two weeks of entering a hospice.
U.S. NEWS reports that these "late enrollees miss the full effect
of hospice, and they likely spend their last months in more-
expensive hospitals" (3/24 issue).
QUESTIONS: Mary Labyak, executive director of the Hospice
of the Florida Suncoast, which could owe the government as much
as $8 million, said, "It is of grave concern to us: What do you
do if people live too long?" Judy Holtz, spokesperson for HHS,
said, "There is no exact science as to when somebody is going to
die, but that is not the issue. This issue is looking at people
being put into hospice unnecessarily, people who are not truly
eligible for the benefit" (TIMES, 3/15). U.S. NEWS reports, "The
government has to decide whether the value hospices provide to
patients is a good value for taxpayers" (3/24 issue).