For many families, hospice is the last ray of sunshine in a long battle with terminal illness. They send a loved one to hospice in order for them to receive personalized care in a comfortable setting. Many of these services are provided in-home, to facilitate the peace of the patient and her family. Unfortunately, unscrupulous and heartless people turn hospice into an opportunity to scam families and the government out of money. This fraudulent activity often leads to lower quality care for terminally ill patients at a time when they need it the most.

The Purpose Of Hospice Funding

Hospice funding from Medicare was created to assist terminally ill patients and their families with meeting the financial demands that inevitably manifest after a terminal diagnosis. This might include access to special medication, supplies, family support systems and medical equipment. While the majority of hospice care is filed under routine home care–care that is provided at home–there are other levels of care that include access to hospice centers and other inpatient facilities that can provide 24-hour care.

Many people rely on Medicare to pay for their hospice care. It is an expensive budgetary component, representing billions of dollars, and the expenditure keeps increasing. From 2007 to 2012, the amount spent by Medicare on hospice benefits has raised a whopping $4.8 billion dollars, with benefit payments amounting to $14.9 billion in 2012. While some of this increase is due to more patients and more costly medical procedures, much of the cost comes as a result of fraudulent billing.

Hospice fraud comes in many forms, some more subtle than others. Some ways that the Medicare hospice might be used fraudulently include

• Billing for services that are not needed or are not performed
• Over-billing for services or procedures
• Falsifying records to deem a person terminally ill who does not meet the standard qualifications
• Paying incentives to nursing homes or physicians to diagnose a person as terminal
• Double-ordering supplies or equipment

The Effects Of Fraud

Those who commit hospice fraud aren’t just taking money from the government, they are taking necessary services from terminally ill patients. This might include equipment or medicine that could make a dying person more comfortable in their final months.

In extreme cases, hospice fraud can lead to the death of a patient who might have had more time to spend with family and friends. In one sad case of hospice fraud, a home healthcare/hospice agency owner ordered nurses to overdose four patients in order to minimize paybacks. Palliative medicines like morphine were given to patients at two to three times the maximum allowed.

Another effect that hospice fraud has is not monetary, and it doesn’t relate to the patient, but the patient’s caregivers and family. It is the naive family member who often suffers from fraudulent hospice agencies. Family members inevitably feel the guilt associated with doing something “wrong” in the care of their dying relative. If they are being denied care, a loved one can feel helpless and angry.

Preventing Future Fraudulent Activity

Due to the increased funding provided to hospice agencies and the unending roll of fraudulent companies popping up all over the country, the government has initiated an Anti-Fraud provision to the Affordable Care Act (ACA) of 2010. The ACA commits $350 million over a ten year period (from 2011-2020) to support the hiring of new agents and implement programs to minimize fraud.

Instead of chasing criminals after they have already defrauded the government, the ACA focuses on preventing fraud from the beginning by pre-screening hospice companies and conducting background checks before allowing them to file claims. It has also provided authority to the Office of Inspector General (OIG) to impose stricter fines and stiffer sentencing for those who knowingly commit fraud.

With more safeguards in place and more people aware of the effects of hospice fraud, those who are legitimately facing a terminal illness will have access to the services they need to live their final months in comfort and tranquility.

Thanks to our friends at Barak Law, Florida Immigration Attorneys, for their contributions to this post.