The Benefits of Hospice Care and The Growing Concern Of Medicare Fraud

Why Hospice Is Beneficial

Hospice care helps and individual avoid unnecessary and costly treatments when fighting a losing battle against their illness. Hospice patients can receive care that provides pain management and comfort while living their final stage of life at home.

Contrary to what many believe, choosing hospice doesn’t mean discontinuing all treatments. For example, if a patient has cancer that is not responding to chemotherapy but is also receiving treatment for high blood pressure, they can choose to start hospice care. Their chemotherapy would cease, but they could continue treatment for their high blood pressure. Medicare pays for some or all hospice care costs, and some private insurance plans may also cover certain expenses.

Increasing Concern of Fraud

Since Medicare covers hospice care expenses for eligible patients, providers bill Medicare for their services. Medicare pays hospice providers a set rate per patient per day, regardless of how much care they receive. Under this reimbursement arrangement, providers are incentivized to have as many patients as possible, with profit as a driving factor, and not necessarily care. 

Since hospice patients often choose end-of-life care in their homes, a significant portion of their care is handled by family members who aren’t compensated for their efforts. Nurses aren’t required to visit more than twice a month. This makes it easy for unscrupulous providers to receive payment for minimal care. 

Regulating the hospice care industry is challenging because no government agency wants to be seen as limiting a valuable service. Surveyors are only required to inspect hospice operations once every three years, allowing providers to operate with very little oversight.  

Avoiding Hospice Care Providers Involved in Medicare Fraud

Knowing that unethical hospice care providers are out there looking for new patients can make it challenging to find a good provider. However, there are helpful resources. 

A simple but effective way of finding a reputable provider is talking with trusted people. A patient's Elder Law Attorney, family, friends, and members of their religious organization are a great place to start. Online reviews can narrow down the selections, along with deeper research on the top choices. Learn whether a hospice provider is a nonprofit or for-profit company, how long they have been in business, and who owns them. 

NHPCO has a program called CaringInfo that is a resource for people looking for hospice or palliative care. CMS's Hospice Center and the National Institute on Aging are other great resources for end-of-life questions.