By Elizabeth E. Hogue, Esq.

Fraud in Hospice Today

Between a Rock and a Hard Place

The crackdown on fraud in the hospice industry has begun and will undoubtedly continue for some time. Many believe that this crackdown is way overdue. Efforts to eliminate fraud are likely to negatively impact the hospice industry; causing significant damage or even destruction of its credibility. The result may be that patients are no longer willing to receive hospice care. These negative effects could spill over to other types of services provided in patients’ homes, such as home health services.

Examples of Fraud in Hospice

Placed in Hospice Care Without Knowledge

A former Louisiana resident was sentenced to 6 years in prison for conspiracy to commit health care fraud and 3 counts of health care fraud. Evidence presented at trial demonstrated that 24 patients were admitted to the hospice who had not been diagnosed with a terminal condition. Many of the patients and their families never knew they had been placed in hospice care. A patient testified at trial that Medicare refused to cover a procedure he needed because, without his knowledge, he was a patient of a hospice.

Fake Charts

A defendant in California told prospective patients that they did not have to be dying to receive hospice services. After collecting identifying information from prospective patients who were not terminally ill, the hospice billed the Medicare Program for services provided to the patients. When the Medicare Program requested additional information to support claims submitted, the owners directed employees to create fake patient charts that were submitted to Medicare.

Make the Patient go "Bye-Bye"

A Texas hospice owner sent employees a text that said, “You need to make this patient go bye-bye.” Giving the owner every benefit of the doubt and allowing for misunderstandings that may arise from text messages, it seems impossible to justify this communication.

Another owner of a hospice in Texas sent a text message to a hospice nurse telling her to take over for nurses who weren’t doing their jobs. The owner went on to say: “I told this chick that if she would just give her 1 ml of Ativan and turn her she would die,” and “[expletive] woman is still alive…I need boots on the ground.” After the nurse took over the care of the patient, as instructed, the owner then texted “nice work.”

Hospice Without a Terminal Illness

A physician was the medical director of several hospice companies. He fraudulently certified that patients of these hospices had terminal illnesses when they did not. In 2015, the physician was listed as the attending physician for more hospice claims paid by the Medicare Program than any other doctor in the country.

Kickbacks

The medical director of another hospice with dozens of locations certified unqualified patients for hospice care. In addition to payment for his services as medical director, he received other perks, including luxury trips and bottle service at exclusive nightclubs.

Final Thoughts

The need for enforcement action is clear, but what effect will these efforts have on the general public and the public’s willingness to use hospice and other services? The backlash from learning that providers who are supposed to care for patients and their families in their dying moments actually engaged in fraudulent conduct may be horrendous – even catastrophic – in terms of utilization of hospice services. Even compliant hospices and other types of providers may feel severe adverse effects. So sad for everyone.

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Elizabeth E. Hogue, Esq The Rowan Report

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.