A report issued by the Office of Inspector General (OIG) at the Department of Health and Human Services summarizes a decade of research into inadequate care, inappropriate billing, and fraudulent, criminal practices by hospice facilities, which accounted for $16.7 billion in Medicare payments in 2016.  Issues cited on the report include elderly patients in uncontrolled pain or respiratory distress for over half a month, initiating routine care only and rare or nonexistent acute care on weekends, recruiters going door to door to solicit fraudulent schemes and luring healthy patients to sign up for hospice who simply don’t need it.  The summary was released this month by government watchdog agency, Kaiser Health News, asking for increased federal oversight.The Medicare hospice benefit traditionally pays for agencies to send nurses, aides, social workers, and chaplains to visit patients likely to pass within six months and who agree to forgo curative treatment.  Yet, Kaiser revealed hundreds of facilities abandoned families at the brink of death or skipped out on other services they were required to provide.

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The report calls on the Centers for Medicare & Medicaid Services (CMS) to take fifteen actions to improve oversight, including tying payment to quality of care and publishing public inspection reports.  In a response sent to OIG, CMS Administrator Seema Verma objected to those two recommendations as well as six more while agreeing with the other recommendations.  Verma wrote that CMS is “committed to ensuring that the Medicare hospice program provides quality care safe from fraud, waste, and abuse,” and also said CMS has taken various actions, including auditing certain hospices’ medical records before claims are paid, monitoring hospices that have many patients in nursing homes and recouping money from hospices that inappropriately billed Medicare for general inpatient care stays.“Hospice is quite different than it used to be,” the watchdog's report lead author Nancy Harrison, deputy regional inspector general of the OIG’s New York office, said. “When it started out, there were faith-based and nonprofits,” mostly for cancer patients.  As of 2016, there were 4,374 hospices receiving Medicare funding, two-thirds of which were for-profit.Fraud has been rampant in Mississippi, where hospices were paying recruiters to solicit door to door business offering free housecleaning, medication, and doctors’ visits to patients who signed up without knowing they were actually enrolling in hospice and forgoing Medicare payment for curative care.  Charles Hackney, an assistant special agent in charge of overseeing OIG investigators in Mississippi, said the fraud has subsided only after many criminal convictions.Edo Banach, president of the National Hospice and Palliative Care Organization, an industry group, said, “incidents of deliberate fraud and abuse in the hospice community, though rare and isolated, are indefensible.”  He added his group aims to work with the current presidential administration to “simplify and streamline the compliance process” in a way that “encourages honest and law-abiding hospice providers” while protecting against fraud.  Banach hopes the OIG will examine an issue that was not included in the watchdog group's recent report, “underutilization of hospice care, which keeps too many Americans from accessing quality end-of-life care when they need it.”

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