Increase in Hospice Care results in Increasing Fraud and Abuse

July 6th, 2011 by Qui Tam

The New York Times reports that hospice care is under the microscope for care and treatment that may not be necessary.  The amount of money spent on hospice care grew from $2.9 billion in 2000 to more than $12 billion in 2009.  The increase is attributable to Medicare regulations some years ago that demonstrated that allowed for hospice care as a cost-effective way of caring for individual near the end of life.  Once a patient is enrolled in hospice care, Medicare pays a flat fee for hospice care, depending on the level of service, regardless of whether a hospice actually provides services.  This rule had a perverse effect of encouraging hospices to find patients likely to live longer.  The system allows hospice care providers to beat the system and get reimbursed even if care is not provided.  The system has prompted the Center for Medicare Services to limit hospice care to 6 months unless a physician or nurse practitioner certifies that longer treatment is needed. 

 Hospice care abuses have resulted in a number of settlements of fraud charges that the government has prosecuted. 

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