Hospice Malpractice Costing Medicare Billions

Hospice Malpractice

Hospice malpractice is draining Medicare of billions of dollars, according to a recent analysis of more than one million hospice patients by the Washington Post.

The investigation found that patients are remaining in hospice care longer, and some are even being discharged alive from hospices nationwide. Traditionally, hospices have been provided respite care for the terminally ill who have six or less months to live.

Rising number of live discharges from hospices nationwide

According to the Washington Post, the number of patients discharged from hospices rose 50% between 2002 and 2012. In some hospice chains, the number of live discharges grew as high as 78%. Most of the money used to fund that patient care comes from the U.S. government, in the form of Medicare payments. The numbers are leading some to cry Medicare fraud.

According to MedPac, Medicare patients must meet specific criteria before qualifying for hospice care. First, the patient must receive a life expectancy of six months or less from two different physicians. Patients must also agree to forgo conventional medical care for both their terminal illness and any related conditions. Patients are also assessed at prescribed intervals during their hospice care to be sure they still qualify for benefits under Medicare standards.

However, the physicians providing those re-approval assessments once the patient is enrolled by a hospice are usually employees of the hospice. Considering the financial incentive to admit patients and keep them in hospice care for as long as possible, many are questioning the credibility of those assessments. According to a report by MedPac, almost 60% of the money Medicare shelled out for hospice care in 2011 went to patients who remained in hospice care more than six months.

Financial incentive could be reason

While some of those patients simply outlived their life expectancy, others may have remained due to the financial incentive and possible hospice malpractice. Although MedPac, a Medicare watchdog organization created by Congress, has pushed for revisions to the way hospice payments are handled, both Medicare and the hospice industry have resisted those revisions.

The rise in longer hospice stays appears to be directly proportionate to the number of for-profit hospices rising up across the U.S. The problem is twofold. In addition to the money paid out by Medicare to these for-profit organizations, patients are also ending up in hospice care that might not be facing imminent demise. These patients are forgoing conventional medical treatment for comfort-driven care as they wait to die, even though they might not be terminal at all.

“It must be strange to be told you’re dying and then not die,” one lawyer who spoke with the Washington Post stated.

Legal advice from malpractice attorneys

Medicare fraud of this nature makes the hospice care system less reliable for patients who truly need it. It also puts patients who do not necessarily qualify for hospice care in a situation where they believe they are going to die soon. If you or a loved one is a victim of this type of hospice malpractice in New York, help is available.

The Sanders Firm has decades of experience working with families who have been victims of medical malpractice, including that involving hospice care. We understand the physical and emotional strain this type of fraud places on the entire family. To discuss your legal rights and receive a free case assessment, call the Sanders Firm at 1.800.FAIR.PLAY. Resources

  1. Washington Post, Hospice Firms Draining Billions from Medicare, http://www.washingtonpost.com/business/economy/medicare-rules-create-a-booming-business-in-hospice-care-for-people-who-arent-dying/2013/12/26/4ff75bbe-68c9-11e3-ae56-22de072140a2_story.html
  2. MedPac, Assessing Payment Adequacy and Updating Payments: Hospice Services, http://www.medpac.gov/transcripts/hospice_December2013_Public.pdf