April 23, 2021
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. Hospice fraud occurs when Medicare Part A is falsely billed for any level of hospice care or service.
Report potential hospice fraud, errors, or abuse if:
- You or someone you know was falsely certified as being terminally ill – that is, with a life expectancy of six months or less if the disease runs its normal course
- You were enrolled in hospice without you or your family’s permission
- You find out someone is falsely certifying or failing to obtain physician certification on plans of care
- You were offered gifts or incentives to receive hospice services or to refer your friends and family for hospice services.
- You see on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) that you were billed for a higher level of care than was needed or provided or for services not received
- You hear about assisted living facility and/or nursing home residents being targeting for hospice services even though their life expectancy exceeds six months
- You come across marketers using high-pressure and unsolicited marketing tactics of hospice services
- You receive inadequate or incomplete services, including, for example, no skilled visits in the last week of life
- You are provided/offered gifts or incentives, including noncovered benefits such as homemaker, housekeeping, or delivery services, to encourage you to elect hospice despite not being terminally ill
- You hear about hospice beneficiaries being abused or neglected by a hospice worker
- You hear about a hospice worker stealing a beneficiary’s medication
- You are kept on hospice care for long periods of time without medical justification
- You were provided less care on the weekends and the beneficiary’s care plan was disregarded
Source: SMP Resource Center
If you suspect Medicare fraud, contact Ohio SMP at 1-800-488-6070, use the “Report Fraud” button on this App or click here.