Hospice Fraud and Abuse: 15 Shocking Example Cases

Is your family member being scammed at a time when they need help the most? It is called hospice fraud and abuse and, unfortunately, happens more than most people realize. Worse, these criminals can be doctors and nurses with little regard for your loved one’s well-being or medical insurance.

This type of healthcare fraud is one the rise and the ramifications of this crime can destroy a person’s ability to be cared for and cost the government millions of dollars. While it is difficult to fathom anyone being tricked by those there to serve them, 31% of the time hospices do not give the care to patients that they claim they do.

What Are Some Examples of Hospice Fraud and Abuse?

Hospice care is when chronically or terminally ill people are cared for by specialized medical staff. This staff may include doctors, nurses and others who provide healthcare, attention, medicine, and spiritual care.

The focus of hospice care is generally about the quality of life, as opposed to extending life or length of life. The severe reasons behind any human needing hospice care are part of why hospice fraud is one of the most horrific types of fraud in our world.

Hospice fraud might look like:

1. A care facility billing for more hours of visits than the patient received. Your loved one ends up neglected, and you have no idea.
2. Are you receiving patient referral kickbacks? The care facility promotes additional care which was not needed, to collect extra funds.
3. Billing for higher level care. Your loved one isn’t given the aid they so desperately need, but higher-level care is still billed.
4. Billing for services and are not given to the patient. Therapies etc. may be charged for but never received.

   
5. Hospice staff convincing family members to suspend their loved one’s hospice care when expensive treatment is needed.
6. Billing for inpatient care when the patient is outpatient. This may cause delays when your loved one needs inpatient care.
7. Overcharging each type of service. The care facility pads their pockets through overcharging for service.
8. Hiring less qualified healthcare staff and not registered nurses, or limiting doctor visits.
9. Lying about a patient’s life expectancy, to get them admitted to hospice.
10. Limiting oxygen for patients who need it or not giving adequate pain medications.
11. Staff is manipulated into more work than they can handle and patients suffer.
12. The family of the cared for the patient is given false information.
13. Grieving family members or ill patients lack the energy or means to fight against the deception.
14. A dying patient’s needs make it impossible to resolve the problem in time.
15. Staff members who help with fraudulent billing and practices are promoted and given powerful positions in the company, while those who don’t comply leave or are fired.

Why Is It Becoming a Problem and What Can Be Done to Stop It?

Hospice fraud often targets Medicare recipients. According to the government, there has been an increase in hospices in the United States of about 43% over ten years (2006-2016). However, Medicare fraud has also increased. For one year, improper billing in healthcare is thought to reach as high as $60 billion.

How to Protect Your Loved One from Hospice Abuse

• Visit your loved one often.
• Ask questions – to the staff, doctors, nurses, etc.
• Review billing to Medicare.
• Investigate the hospice facility online.
• Search online reviews of the doctors or nursing staff.

Report suspected fraud immediately. The FBI states: “If you suspect fraud, contact your health insurance company (most have toll free numbers to report fraudulent activity). Medicare fraud can be reported to 1-800-HHS-TIPS (1-800-447-8477). You also can contact your local FBI or HHS-OIG offices or your state’s Medicaid fraud office.

While Medicare has been attempting to correct these actions with an investigation and public awareness, this is still a widespread problem, and your loved one’s safety is ultimately in your hands. Do your part with a medical staff search at Social Catfish and trust your intuition! If something doesn’t feel right about your loved one’s care, you may be correct!