A report published in late 2022 revealed how lax oversight and the opportunity to earn significant profits had transformed the end-of-life industry in the United States from a movement based on altruism into a $22 billion business. The investigators discovered that hospice entrepreneurs were particularly active in Texas, Arizona, Nevada and California. The abuse and neglect that was uncovered by the ProPublica and New Yorker investigation led to a public backlash, and it has also prompted the Centers for Medicare and Medicaid Services to introduce stricter hospice inspection guidelines.
Revised inspection criteria
CMS inspectors will now be required to do some research before they inspect an end-of-life facility. They have been ordered to check patient reviews, complaints from family members and news reports before they begin an inspection. Inspectors are also urged to pay particular attention to hospices that release an unusually high number of live patients. When hospice patients are released alive, it is often a sign that the facility is violating hospice law by admitting people who do not meet the criteria for end-of-life care.
The new CMS inspection guidelines have been put into place to protect taxpayers as well as hospice patients. Rampant Medicare fraud in the end-of-life industry has led to calls for stricter oversight from both sides of the political aisle. In the three months since the results of the hospice investigation were published, bipartisan groups of lawmakers from both the U.S. Senate and U.S. House of Representatives have sent the CMS administrator letters demanding action.
Protecting the most vulnerable
Hospices provide care to some the country’s most vulnerable patients, and they should strive to maintain the highest possible standards. A catalog of abuse cases and fraud investigations is clear evidence that many end-of-life facilities care more about money than caring for their patients, and they should be held accountable. Stricter CMS inspection guidelines are a good first step, but more needs to be done.