HOSPICE: Growing Fraud Strains Regulators
Hospice care, "the fastest-growing segment of the federal Medicare budget," is producing "a new brand of fraud and abuse that is straining a regulatory system that was never designed to handle the expanding network of nursing homes, hospices, assisted-care centers and other services popping up to serve the nation's growing aging population." The New York Times reports that as "specialized care for people on the brink of death has boomed," Medicare paid $2 billion last fiscal year for hospice care, "nearly double the amount paid four years earlier." The hospice program was initiated in the mid-1970s "as a voluntary, charitable effort to make death more humane." However, the "industry began to change in 1983" when additional Medicare coverage "dramatically expand[ed] access to the benefits and [drew] for-profit operators into the field." A recent investigation of fraud within the hospice system showed "how easily people can maneuver within the Medicare system to commit multimillion-dollar frauds." A Chicago federal grand jury found abuses including "patients who were not dying, creating phony lists of recipients and siphoning off millions of dollars to companies controlled by the hospice owner," all to the tune of $28.5 million in fraud.
Scene Of The Crime
The Times notes that "hospice abuses are worst in nursing homes," with an estimated one out of three nursing home patients receiving hospice care for which they are not eligible, according to a federal report. The report found that many nursing home patients receiving hospice care "do not have six months or less to live" as required by law to qualify for hospice coverage. While "the average benefit last fiscal year was about 55 days ... one government study found that the average stay in the hospice program for nursing home patients was 166 days." Nursing homes are particularly "vulnerable to abuse because they offer a sizable pool of potential patients." Recent investigations revealed "instances in which hospices and nursing homes have struck agreements in which the hospice pays extra money to the home in exchange for exclusive access to its patients."
Further Action Needed
"Hospice industry officials counter that the accounts of abuse are exaggerated," although the National Hospice Organization plans to "issue guidelines soon to clarify the relationship between hospices and nursing homes." NHO Vice President Galen Miller notes that "[t]here have not been a lot of guidelines for hospice patients in nursing homes." Meanwhile, federal and state agencies say they lack "the resources to monitor the growing network of" facilities providing hospice care (Frantz, 5/10).