Exploding hospice industry vulnerable to fraud, OIG says

September 10, 2018

The hospice care industry has ballooned in interest over recent years. But at the same time, nursing home residents and others receiving such care are often subject to improper care and fraudulent billing, according to a new government report released Tuesday.

In 2016 alone, Medicare paid some $16.7 billion for services to about 1.4 million patients. That’s more than 81% more than the $9.2 billion spent a decade prior to 1 million beneficiaries, the Health and Human Services Office of the Inspector General noted in its new report. About one-quarter of beneficiaries received hospice care in a nursing home or skilled-nursing facility in 2016.

Given those vulnerabilities — along with recent government actions against hospice providers, such as this one — the OIG took a closer look at hospice use dating back to 2005. Its investigator found vulnerabilities in the program, including that patients sometimes receive poor and/or unnecessary acre, and providers often don’t share crucial information to help nursing home residents and others make informed decisions. Hospices provided fewer services than outlined in care plans for 31% of claims for beneficiaries residing in nursing facilities, for instance.

“No one wants their loved ones to suffer needlessly in their final days. We need to improve hospice care for our mothers, our fathers, our friends, ourselves,” Nancy Harrison, deputy regional inspector for HHS and lead author of the report, said in a news release. “It is so important to have reliable information and good resources when you’re facing a terminal illness and considering hospice care. As it stands now, you have the least information when you are thinking about end-of-life care.”

In its 45-page report, the OIG also recommended several steps to fortify the hospice program. Those include strengthening the survey process to better ensure that hospices provide beneficiaries with quality care and necessary services; giving the federal government more authority to address poor-performing hospice providers; educating nursing home residents and their families about the hospice benefit; and strengthening oversight of hospice providers to reduce inappropriate billing.

The inspector general also suggested decreasing payment for hospice care delivered at nursing homes, which already provide some similar services.