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.

What is Medicare Hospice Fraud?

Hospice fraud occurs when Medicare Part A is falsely billed for any level of hospice care or service.

What are Examples of Hospice Fraud?

  • Falsely certifying and providing services to beneficiaries who are not terminally ill — that is, with a life expectancy of six months or less if the disease runs its normal course
  • Enrolling in hospice without the knowledge or permission of the patient or family
  • Falsely certifying or failing to obtain physician certification on plans of care
  • Paying gifts or incentives to referral sources (such as physicians and nursing homes)
  • Billing for a higher level of care than was needed or provided or for services not received
  • Targeting assisted living facility and/or nursing home residents whose life expectancy exceeds six months
  • Using high-pressure and unsolicited marketing tactics of hospice services
  • Providing inadequate or incomplete services, including, for example, no skilled visits in the last week of life
  • Providing/offering gifts or incentives, including noncovered benefits such as homemaker, housekeeping, or delivery services to encourage beneficiaries to elect hospice even though they may not be terminally ill
  • Embezzling, abusing, or neglecting beneficiaries or medication theft by a hospice worker
  • Keeping a beneficiary on hospice care for long periods of time without medical justification
  • Providing less care on the weekends and disregarding a beneficiary’s care plan

What Can You Do to Stop Hospice Fraud?

  • Be sure your doctor has assessed your condition
  • Be sure your doctor has certified that you are terminally ill and expected to live six months or less if the disease runs its normal course
  • Never accept gifts (such as money, gift cards, or groceries) in return for hospice services and be wary of “too-good-to-be-true” offers
  • Report quality-of-care complaints to your local SMP and the Beneficiary and Family Centered Quality Improvement Organization (BFCC-QIO)

How are Fraudsters Benefiting from Hospice Fraud?

General inpatient care and continuous home care pay significantly more than routine home care. Falsely signing someone up for hospice and then providing routine home care at a continuous home care rate could be very lucrative for a fraudster.

Source:  https://www.smpresource.org/Content/Medicare-Fraud/Fraud-Schemes/Hospice-Fraud.aspx