Hospice Care and Medicare Fraud

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Users of hospice care programs should be on alert. Currently, the Office of Inspector General has sent out a fraud alert regarding hospice and nursing home fraud. The way Medicare is set up contributes to the number of fraud cases regarding hospice care systems. 

Medicare: Contributing to the Problem

Medicare provides hospice care coverage for terminally ill patients. To be classified as terminally ill, a patient must have a life expectancy of six months or less. Once they have received this classification, the patient is no longer allowed to have any curative care. They can use their non-Medicare practitioner for a cure, but Medicare will only pay for hospice care. This form of care covers the managements of symptoms, counseling and pain medications. 

Medicare only pays for hospice care if it is in the patient’s home. This translates into a system designed to pay care providers the same amount of money for at-home care and nursing home care. The patient has to pay for their own room and board if they choose to stay in a nursing home unless they can convince Medicaid to cover it. The Medicare program will pay the nursing home 95 percent of their fees for the nursing home stay and will outsource any other services. 

The entire system is set up unintentionally to be abused. Hospices and nursing homes will make agreements to contract with each other for hospice care in the nursing home. The hospice sets up exclusive contracts that ensure the nursing home continues to send their patients to the hospice’s business. In the end, this sets up a situation where the hospice could be enticed to give the nursing home kickbacks in exchange for new patients. 

Often, care provided in a nursing home overlaps with hospice care services. In these situations, the hospice provider is paid for a service the nursing home already carries out. Suspiciously, patients in nursing homes are statistically more likely to have a longer treatment. One study actually showed that nursing home patients will actually receive fewer services than a patient that stays at home for their care. Hospice care providers might even be encouraging the decrease in services. Every reduction in services lowers the labor costs of the hospice care service and makes their business more profitable. 

Popular Hospice Frauds

Hospices who offer fraudulent services may give a nursing home cheaper services or products to receive more patients. In addition, the hospice may pay the nursing home more for its patients to encourage the nursing home to send future referrals to the hospice. To work around the system, a hospice may provide services already offered by the nursing home. This reduces the cost of labor for the nursing home and serves as an illegal kickback. 

If hospice providers or staff members know of Medicare fraud, they should immediately contact an attorney. Whistleblowers are legally protected by the government and should report any incidents or kickbacks occurring in their hospice care business. 

Report Hospice Fraud here.

You can stop abuse of government funds by becoming a Medicare fraud whistleblower and get a substantial reward for your information. Our attorneys have a lot of experience representing those who expose fraud in the healthcare industry. To get a consultation with a lawyer free of charge, you may fill out the secure and confidential form on this page, or contact us at 1-866-648-5223.


Last modified on Wednesday, 05 September 2012 09:31
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