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Hospice fraud leads to strict new regulations

On Behalf of | Jul 24, 2023 | Health Law Attorneys, Medicare & Medicaid Fraud

The end-of-life care sector in Texas and around the country was once a relatively small part of the health care industry that was dominated by charities, but it has now grown to become a $33.06 billion industry. Experts believe that the hospice sector will grow to $80.96 billion by 2032, and they expect the number of facilities providing end-of-life care to double. Providing hospice care in the United States has become extremely profitable, and that has led to several high-profile fraud cases, regulatory scrutiny and much stricter oversight.

Medicare fraud

Committing Medicare fraud is easier in a hospice because patients nearing the end of their lives receive costly treatment on a daily basis. Medicare fraud costs American taxpayers about $60 billion each year according to a report published by CNBC in 2018, and much of that money is obtained by submitting fraudulent hospice claims. Schemes involving fraudulent business practices and illegal kickbacks are often traced to hospices that have opened recently. These newer hospices tend to be located in Texas, Nevada, Arizona and California.

Strict new regulations

In response to this wave of hospice Medicare fraud, lawmakers have strengthened hospice laws and introduced tough new regulations. Hospices must now keep daily records of the medications administered to their patients as the auditors tasked with investigating fraud have been told to look for dose discrepancies, and facilities that cannot provide complete and accurate records in a timely manner are subjected to even closer scrutiny. Some hospice industry groups think the government has gone too far. While speaking at a trade conference in New Orleans, the president of the National Association for Home Care & Hospice said federal regulators were creating more paperwork for hospices while doing little to address the underlying causes of fraud.

Inevitable consequences

Rapid growth and record profits will always attract scammers and fraudsters, and regulators usually respond with tough regulations and harsh penalties for violating them. Hospice trade groups may balk at the strict oversight that end-of-life care facilities are being subjected to, but these measures are the inevitable consequences of rampant fraud.