SMP National Resource Center 10 Examples of Hospice Fraud

SMP National Resource Center 10 Examples of Hospice Fraud

Hospice is an important benefit for the Medicare population. Hospice fraud threatens this benefit for all beneficiaries. Scammers are getting beneficiaries to agree to hospice care even though they do not qualify for the benefit.

What is Medicare Hospice Fraud?

Hospice fraud occurs when Medicare Part A is falsely billed for any level of hospice care or service.

What are Examples of Hospice Fraud?

• Falsely certifying and providing services to beneficiaries who are not terminally ill — that is, with a life expectancy of six months or less if the disease runs its normal course
• Enrolling in hospice without the knowledge or permission of the patient or family
• Falsely certifying or failing to obtain physician certification on plans of care
• Paying gifts or incentives to referral sources (such as physicians and nursing homes)
• Billing for a higher level of care than was needed or provided or for services not received
• Targeting assisted living facility and/or nursing home residents whose life expectancy exceeds six months
• Using high-pressure and unsolicited marketing tactics of hospice services
• Providing inadequate or incomplete services, including, for example, no skilled visits in the last week of life
• Providing/offering gifts or incentives, including noncovered benefits such as homemaker, housekeeping, or delivery services to encourage beneficiaries to elect hospice even though they may not be terminally ill
• Embezzling, abusing, or neglecting beneficiaries or medication theft by a hospice worker
• Keeping a beneficiary on hospice care for long periods of time without medical justification
• Providing less care on the weekends and disregarding a beneficiary’s care plan

Medicare’s most indefensible fraud hotspot: Hospice care

• The number of hospices in the US increased by 43 percent between 2006 and 2016, but with the boom in end-of-life services, Medicare fraud also has risen.
• Medicare fraud and inaccurate billing costs the federal government health care program as much as $60 billion annually.
• The amount of Medicare beneficiaries receiving hospice care increased by about 53 percent between 2006 and 2016, with 1.4 million Medicare beneficiaries receiving hospice care in 2016. Spending increased by 81 percent to a level of $16.7 billion in 2016, according to a new report from the Inspector General at the Department of Health and Human Services.

Fraud, waste, and abuse in the Medicare hospice program is ‘repellent’

Fraud, waste, and abuse in the Medicare hospice program is ‘repellent’

The Department of Health and Human Services’ Office of Inspector General, for which I work, recently published a report examining hospice practices over a decade. It showed that hospices do not always provide the services that patients need and sometimes provide poor-quality care. We also found that patients and their families often do not receive crucial information to make informed decisions about hospice care.

Bay Area’s Largest Home Health Care Agency And 28 Health Care Industry Workers Charged In Patients-For-Cash Kickback Scheme

Amity Home Health and CEO, Ridhima “Amanda” Singh, And 13 Doctors Are Among Dozens Charged In Alleged Multi-Million Dollar Scheme to Receive Referrals for Medicare Patients

SAN FRANCISCO – Federal complaints have been filed against 30 defendants charged in a patients-for-cash kickback scheme, announced United States Attorney David L. Anderson,  Federal Bureau of Investigation Special Agent in Charge John F. Bennett, and Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG), Steven J. Ryan.  

DOJ Recoups $2.6 Billion from Home Health Fraud, Other Schemes in 2019

The 2019 fiscal year concluded with the Department of Justice (DOJ) bringing in $2.6 billion in recoveries involving health care fraud and false claims.

Home health-related fraud was a large part of these efforts. 

This marks the 10th consecutive year that the department’s civil health care fraud settlements and judgments have exceeded $2 billion. The recovery amount only includes federal losses.

OIG Puts the Pressure On as Hospice Fraud Cases Pile Up

OIG Puts the Pressure On as Hospice Fraud Cases Pile Up

In March 2018, Health and Palliative Services of the Treasure Coast and two of its businesses paid $2.5 million to settle a False Claims Act (FCA) case related to hospice billing.

A month later, Horizons Hospice agreed to pay more than $1.2 million to resolve allegations that the company fraudulently billed Medicare and Medicaid for services to patients who did not have a life expectancy prognosis of six months of less.

Today is the 38 Month Anniversary of the Medical Murder and ILLEGAL DNR of My Beloved Husband Bill Knightly by St. Joseph Hospital in Nashua, NH

Today makes 38 months since the Medical Murder and ILLEGAL DNR of My Beloved Husband, My Knight in Shining Armor, Bill Knightly. Murdered by SO-CALLED Medical professionals who took an oath to SAVE lives, NOT KILL. Medical professionals who no longer feel life is precious and worth fighting for. They now believe Our Loved Ones are expendable and not worth saving. The profit they make off of killing Our Loved Ones is ALL they care about. And then they lie to CMS, stating My Husband was not on Hospice/Palliative care. Legally, he wasn't. Illegally he was and I have ALL the bills and documentation to prove it and sent ALL of it to CMS, who continue to side with the Hospital. If the Hospital told the truth, they would be in trouble and they would have gotten less money. They billed Medicare at a much higher rate than they would have gotten for Hospice/Palliative Care. They ILLEGALLY billed for care My Husband NEVER received. I guess CMS doesn't care about Medicare Fraud. How many other's have been Murdered by ILLEGAL Hospice/Palliative care while the Hospital billed and were paid for FULL services?
My Husband was one of a kind and his Medical Murder has traumatized many. Unfortunately, the Medical UN-PROFESSIONALS responsible for his death AND the State of New Hampshire couldn't care less about the senseless Murder of My Husband or the many other's Medically Murdered just to save a dime. Proof of wrongdoing and Murder goes UN-punished. The Murderers given a free ride to continue Murdering Our Loved Ones. And at a Catholic Hospital at that. Never in my wildest dreams could I ever believe this could happen within a Catholic Hospital or ANY hospital in America for that matter. I was born and raised in the Catholic Church, but I  stopped going when my grandson was put in a Catholic Orphanage by DCYF and adopted out to stranger's, after promising he would come home with us. Murdering My Husband was the last straw. You can't get your tubes tied at a Catholic Hospital, but they will kill you for profit.
ALL Life is precious and ALL lives are worth saving. Money truly IS the root of ALL evil.
When someone WALKS into a Hospital and requests treatment, they BELIEVE they are going to get the best treatment possible, not be Murdered instead, where requests of treatment fall on deaf ears. My Husband was DENIED a blood transfusion, even though he DONATED blood MANY times throughout his life. The scumbag Hospitalist stated, "Why waste the blood on him when someone else could use it more?" Total POS! He denied My Husband EVERYTHING we requested, including TRANSFER to a REAL Hospital, held in that shithole against our will. Still, the State of New Hampshire does absolutely NOTHING.
My Love for My Precious Husband will live on FOREVER AND He will NEVER be Forgotten! I'll make sure of it! I will continue to expose Hospice/Palliative care for what it really is and I will keep on shouting from the rooftop's for as long as it takes to get My Husband the Justice he deserves along with all the other's Medically Murdered.

I Love you My Knight and always will! Extremely Pissed Off Wife of Bill Knightly, Murdered by NON-consensual Hospice/Palliative care at St. Joseph Hospital in Nashua, NH