Missed Visits, Uncontrolled Pain and Fraud: Report Says Hospice Lacks Oversight

By News, Kaiser Health | Pasadena Star-News, July 31, 2018 | Go to article overview

Missed Visits, Uncontrolled Pain and Fraud: Report Says Hospice Lacks Oversight


News, Kaiser Health, Pasadena Star-News


Elderly patients spent over two weeks in uncontrolled pain or respiratory distress. Acute care was rare on weekends. And recruiters went door to door pitching fraudulent schemes, luring healthy patients to sign up for hospice in exchange for free housecleaning and medicine.

These details appear in a report on hospice released Monday by a government watchdog agency calling on federal regulators to ramp up oversight of a booming industry that served 1.4 million Americans in 2016.

The report from the Office of Inspector General (OIG) at the Department of Health and Human Services sums up over 10 years of research into inadequate care, inappropriate billing and outright fraud by hospices, which took in $16.7 billion in Medicare payments in 2016.

The Medicare hospice benefit aims to help patients live out their final days in peace and comfort: It pays for agencies to send nurses, aides, social workers and chaplains to visit patients who are likely to die within six months and who agree to forgo curative treatment for their terminal illness. Most of the time, this care takes place where the patient already lives — their home, nursing home or assisted living facility.

A Kaiser Health News investigation last year revealed that while many of the nation’s 4,000-plus hospices earn high satisfaction rates on family surveys, hundreds fell short of their obligations, abandoning families at the brink of death or skipping other services they had pledged to provide.

The OIG report points to similar gaps in care and raises concerns that some hospices are milking the system by skimping on services while taking in daily Medicare payments.

Regardless of how often their staff members visit, hospices collect the same daily flat rate from Medicare for each patient receiving routine care: $193 for the first 60 days, then $151 thereafter, with geographic adjustments as well as extra payments in a patient’s last week of life.

The report calls on the Centers for Medicare & Medicaid Services (CMS) to take 15 actions to improve oversight, including tying payment to quality of care and publishing public inspection reports on its consumer-focused website, Hospice Compare, as it does for nursing homes.

In a letter to OIG in response to an earlier draft of its report, CMS Administrator Seema Verma objected to those two recommendations as well as six others. She concurred with six other recommendations and wrote that CMS is “committed to ensuring that the Medicare hospice program provides quality care safe from fraud, waste, and abuse.”

The OIG findings include:

Basic care only: In 2016, 665 hospices provided only the most basic level of care, called routine home care. This is a red flag, OIG argues, suggesting that patients may not be getting the care they need: Medicare requires hospices to offer three other types of care — general inpatient care for acute conditions such as uncontrolled pain, continuous care in a crisis and respite care to offer a caregiver temporary relief.

Inadequate acute care: Hospices failed to provide adequate nursing, physician or medical social services in 9 percent of general inpatient care stays in 2012. Examples of poor care included a 101-year-old man with dementia who had uncontrolled pain for 16 days, and an 89-year-old man who had uncontrolled respiratory distress and anxiety for 14 days.

Weekend visits rare: Hospices rarely provided services on the weekends to patients in assisted living in 2012. Hospices were also more likely to provide general inpatient care on weekdays than on weekends, according to an OIG analysis of 2011 data.

Missing services: In nearly a third of Medicare claims filed for patients living in nursing homes, hospices provided fewer services than they promised in patients’ plans of care, according to a 2009 report. This is notable, the OIG argues, because hospices set their own plan of care for each patient, and fell short of the bars they established. …

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