The U.S. Department of Health and Human Services Inspector General has just released a report on hospice care provided through Medicare. After synthesizing patient records and Medicare patient data from more than a decade, the Inspector General concluded that, while most patients can rely on hospice care to relieve their suffering, some hospice providers are neglecting patients and billing for services that were unnecessary or not provided.
The report calls upon the Centers for Medicare and Medicaid services to improve its detection of these problems.
Medicare is a major payor for hospice services in the U.S., and hospice is an increasingly popular benefit. According to NPR, Medicare paid $16.7 billion for hospice care in 2016 -- up from $9.2 billion a decade earlier.
One thing that's different about hospice services is that Medicare pays hospice providers flat rates for inpatient or outpatient care for each patient per day -- regardless of the number or quality of services provided. That can sometimes lead to patients receiving minimal services.
"We found that hospices provide fewer services on the weekends than during the week," says the report's lead author. "Far fewer, actually. And patients would have pain on weekends just as well as they have it on weekdays."
The report also identified one hospice provider who billed Medicare for two weeks of high-level care for a particular patient. The provider, however, never actually visited that patient. Instead, they merely called the patient's family and asked how he was doing.
All in all, the report estimates that Medicare paid $268 million in 2012 for inpatient hospice care when patients didn't need it.
Just as troubling was the fraud uncovered in the report. According to a longtime HHS investigator interviewed by NPR, some patients don't even know they're signing up for hospice services.
"Often these hospice owners will market themselves as 'we will clean your house for free' - in other words, a housecleaning service." Or, lonely people are convinced to sign up just to have a companion.
The consequences of that can be devastating to patients, according to the report.
"When a patient does elect hospice care, they are waiving their right for Medicare payment for curative treatment," says the lead author. "So, in effect, they're giving up curative care. And if they don't know they're doing that, they could be making not the best choice for their future."
The report identified 15 recommendations for how the Centers for Medicare and Medicaid Services (CMMS) could improve the situation. This includes obtaining more data to identify scams and making that information known to the public and to hospital inspectors. The administrator of CMMS, however, has rejected over half of them.