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Medicare offers hospice benefits as a way to help the dying live out their final days as comfortably as possible. But a recent report from the Office of Inspector General at the Department of Health and Human Services finds that patients and their families can be taken advantage of.
The report, released in July, concluded that many hospices provide excellent care. And hospice providers served 1.4 million Americans in 2016 with Medicare spending $16.7 billion for hospice care.
But the Office of Inspector General found some hospices do not manage symptoms or medications appropriately, leaving patients in pain for days. There were instances where families and caregivers did not receive important information to make good decisions about patient care.
And federal inspectors found that hospices’ inappropriate billing cost Medicare hundreds of millions of dollars. The report revealed fraud schemes that involved enrolling patients in hospice who were not eligible for the higher-level of care, while other hospices billed for services that were never provided.
For example, the report found that hospices failed to provide adequate nursing, physician or medical social services in 9 percent of the inpatient stays in 2012. Examples of poor care included a 101-year-old man with dementia who suffered uncontrolled pain for 16 days, and an 89-year-old man who had uncontrolled respiratory distress and anxiety for two weeks.
The report revealed fraud schemes that involved enrolling patients in hospice who were not eligible for the higher-level of care, while other hospices billed for services that were never provided.
“Hospice is quite different than it used to be,” Nancy Harrison, the report’s lead author and a deputy regional inspector general, told Kaiser Health News.
“When it started out, there were faith-based and nonprofits,” she said.
As of 2016, of the 4,374 hospices receiving Medicare dollars, two-thirds were for-profit operations.
The report includes 15 actions for the federal Centers for Medicare & Medicaid Services to take to improve patient care and minimize fraud. They include providing patients and their families with more information about hospices and complaint investigations.
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