Hospices provide much-needed care for individuals with terminal illnesses, offering comfort and support during one of life’s most challenging periods. However, hospice fraud poses a major threat to the integrity of these services in the United States, jeopardizing both patient well-being and trust in the healthcare system.
Understanding hospice fraud and the different forms it can take is crucial for safeguarding the quality of care provided to patients in hospice settings.
Billing fraud
Billing fraud may include intentionally billing for services that were not provided such as exaggerating the level of care needed or charging for unnecessary medical equipment or treatments. It can also involve upcoding, where services are billed at a higher level than what was actually provided, and unbundling, where services that should be billed together are billed separately to increase reimbursement.
Kickbacks
This may happen through fraudulent referrals where hospices offer or receive illegal payments or kickbacks in exchange for patient referrals. This unethical practice can involve financial incentives, gifts or other inducements provided to healthcare professionals, caregivers or even patients themselves in exchange for directing patients to a particular hospice provider.
Improper care
This encompasses a range of deceitful practices aimed at maximizing profits at the expense of patient well-being. This includes falsifying records to fake physician certifications, offering hospice benefits to patients who haven’t been certified as terminally ill with a short enough life expectancy and manipulating patient charts to justify continued care or admission. Hospices may also improperly retain patients whose health is improving rather than declining or focus on enrolling as many patients as possible without ensuring full, adequate care for each individual.
If you suspect hospice fraud, it is important to report it to the appropriate authorities such as the Office of Inspector General (OIG) to help prevent further harm to patients and uphold the integrity of the hospice care industry as a whole. Sometimes, the most helpful information is reported to authorities by others within the industry who notice that their competitors’ practices are not serving patients properly.