Members of Congress want answers on hospice fraud and abuse

In a June 21 letter to Inspector General Christi A. Grimm, five Members of Congress requested a briefing with the Office of the Inspector General to become apprised as to how widespread reports of fraud and abuse at Medicare Certified Hospices were, and what was being done about such illegal activity.

“Unfortunately, a surge of newly certified hospices have been engaged in unlawful, unethical practices, resulting in alarming reports of fraud and abuse that threaten both patient safety and fiscal responsibility,” the letter by Representatives Beth Van Duyne, R-Texas, Earl Blumenauer, D-Ore., Brad Wenstrup, R-Ohio, Jimmy Panetta, D-Calif., Mike Carey, R-Ohio, Lloyd Doggett, D-Texas, Michelle Steel, R-Calif., Darin LaHood, R-Ill. and Brian Fitzpatrick, R-Penn., said.

A November 2022 article by ProPublica highlighted the pressures put on hospice personnel to find and recruit increasing numbers of patients into hospice care, even when statistics for those quotas did not square with the request. It also illuminated strategies devised by hospice operators to turn a profit even when patients weren’t terminal and spent long periods in hospice care.

In an industry as unregulated as the hospice care business, the government’s main defense against hospice fraud depends on whistleblowers, the article revealed. Violation of the federal False Claims Act was reported in 7 out of 10 of the largest hospices by former employees in 2021.

“Hospice is an important service that should be there in some of life’s hardest moments, but fraud is plaguing the system in Southern California. My colleagues and I are demanding answers,” a tweet by Representative Michelle Steel commented.

“Many fraudulent hospices also employ a “churn and burn” strategy through which they apply for new licenses to continue billing Medicare with no change in the number of enrolled patients,” the letter continued. “State auditors in California discovered a recent surge in new hospices, particularly in Los Angeles County with some of these hospices appearing to have been set up with fictional patients and medical staff.”

The letter noted that in January last year a statewide moratorium on licenses for new hospice facilities served only to push questionable hospice operations towards states east of California.

Because of the variety and scope of Medicare hospice fraud, the congress members articulated support for the Office of the Inspector General in addressing the cancerous fraud and questioned whether sufficient oversight was in place for procedures governing state licenses, accreditation, and certification.

“Any inadequacy could harm a critical Medicare benefit that in most cases provides high-quality and person-centered care for patients and families,” it pointed out.

Hospice care is special because it provides for patients in the most vulnerable position i.e. in end-of-life circumstances, giving them the dignity and comfort they deserve, the congress members noted in the letter, but it also serves to avoid expensive and unnecessary Medicare costs associated with inpatient hospital stays and emergency department visits.

The congress members requested updates on hospice fraud caseloads, resources sufficiency to address the proliferation of fraudulent providers, noticeable trends, and the plan of action the Office of the Inspector General is taking to confront the situation - within 14 days.