Is Hospice Providing End-of-Life Care or Committing Medicare Fraud?

Handling Whistleblower Cases Nationwide from Newport News, Virginia

Since 1983 Hospice has been a Medicare benefit for individuals suffering with terminal conditions who have less than six months to live. In theory, the Medicare benefit allows patients to spend their last few months at home receiving comfort care until their death instead of enduring costly end-of-life care in a hospital setting. The program should have saved the government money while allowing patients to die with dignity in their own homes.

Medicare Fraud in Hospice

Rise in Medicare Hospice Spending

The reality however, is that Medicare hospice spending has more than quadrupled in the last decade, reaching costs of over $15 billion a year. Hospice costs have increased because more seniors are using the program, but also because the average length of hospice stay has increased significantly. In 2000, the average patient stay in hospice was just 54 days. In 2011, that average stay had increased to 86 days. In the same time period, the number of for-profit hospices nearly doubled.

Lengthier Stays Benefiting For-Profit Hospice

Curiously, for-profit hospices see the lengthiest stays on average. According to the Medicare Payment Advisory Commission, an independent agency that advises Congress, the average stay at a for-profit hospice in 2013 was 105 days. Nonprofit hospices saw average stays of only around 68 days.

A disturbing report from the Office of Inspector General of the Department of Health and Human Services showed that in a number of patient cases, the patient outlived the Medicare guidelines for a six-month or less hospice stay. To elect hospice care, a treating physician must certify that the patient is terminally ill. Then the patient elects to trade curative care for palliative care.

The report suggests that patients may have been inappropriate candidates for hospice care at the time that they elected the program and may have missed out on crucial medical care.

Financial Incentives in the System

Because patients receive an unlimited number of 60-day periods of care after the initial two 90-day periods, hospice providers are incentivized to recruit patients who may not be terminal. The Inspector General’s report found that in 35 percent of the cases reviewed, the patient election statements to enter hospice care were lacking required information.

Blow the Whistle on Hospice Medicare Fraud

Do you have knowledge of a hospice care provider admitting patients before they are terminal? Do you have evidence of extended stays that constitute hospice Medicare fraud? You can blow the whistle on hospice Medicare fraud, and we can help.

The attorneys at the Anti Fraud Law Group of Patten, Wornom, Hatten, & Diamonstein, L.C. (PWHD) are experienced whistleblower lawyers who can guide you through every step of the case.

You can be rewarded for your efforts in blowing the whistle on Medicare fraud with an award of the percentage of government funds recovered in the case.

Call us today at 757-223-4536 for your free whistleblower case consultation. We can help you evaluate the circumstances in your case and act quickly to bring your whistleblower case. Located in Newport News, we represent clients throughout Virginia and nationwide.