Healthcare Advocacy - Hospice has Issues

January 17, 2023

Jan 18, 2023

Good Day Healthcare Advocates

Every day we advocate for better healthcare for all of us is a good day. Thank you also to all of you advocates who have recently subscribed and to those who have asked for particular topics (use the comment button below). Some of the topics in work are the middlemen benefit managers and rural healthcare. Thank you.

Mission

The Healthcare delivery system in the United States is a patchwork that leaves much to be desired. It is the most expensive system among the top 35 industrial countries and covers far fewer participants delivering lower levels of quality care than many of our peer nations. This blog will provide:

Current problems in healthcare
Actions you can take
References

Current State of Affairs – Hospice Cheating on Death’s Door

First a word about kinds of care. Palliative care makes the patient more comfortable but continues curative treatment. Hospice care seeks to make the patient comfortable as well, but there is no curative treatment.

The hospice industry was largely started by a deep desire to be compassionate to those that were dying. The groundbreaking book “On Death and Dying”, written by Elisabeth Kubler-Ross, provided guidance about the kind of care the dying needed and wanted. It also taught those that were grieving what grief will be like so they know what to expect (The 5 stages of grief).

According to the NIH, hospice provides comprehensive comfort care as well as support for the family, but, in hospice, attempts to cure the person's illness are stopped. Hospice is provided for a person with a terminal illness whose doctor believes he or she has six months or less to live if the illness runs its natural course.

That sounds great - all for it.

Fun Fact - Medicare covers much of hospice care. Is it a fee for service, like for doctors? No. Medicare has a daily rate they pay for each person in hospice up to 6 months with some extensions possible. And if too many of the patients signed up with a hospice live more than 6 months then Medicare demands repayment of some of the fees. PS in 2022 hospice was a $22B industry and it continues to grow.

According to a New Yorker and ProPublica investigation for profit hospices were 30% of the business in 2000 today 70%. For profit providers margins are three times their non profit providers margins . That means that non profit providers have a significant amount more (10%) of the Medicare payment available to keep service levels high. Another problem is that Medicare operates, mainly, on an honor system with regard to these payments.

As you can imagine this is a scenario ready for exploitation. Unethical hospices could

Skimp on services (especially when care is at home and the family can pick up some of the slack)
Enroll patients who don’t need the service
(requires cooperation of nurses/doctors - bribes/kickbacks involved)
Keep wages low and use less qualified staff
Discard patients at 6 months who lived so as to not repay Medicare
Use identity theft to sign up healthy people without their knowledge

Bad news - greedy providers did all of this.

What to do

Check what services will be provided, how many hours/day, baths, meals, dispense medication etc. - make sure it is enough before you sign
If you don’t need it don’t let anyone sign you up. I’m sure there is a kickback to the patient in some way (free services, cash, etc.) but if you actually need a doctor’s care and are on hospice you may not be able to get it.
Check for identity theft. I was a cyber security person and medical identity theft is one of the most common. Check your Medicare/Insurance statement to see if everything insurance said they paid was actually for you. Look for double billing etc. If it does not look right, get on the phone to them immediately and also check credit reports as they may be stealing cash in your name as well.
1. Call the Senior Medicare Patrol in your state (authorized by US Gov’t) at the link below
  1. https://www.smpresource.org/Default.aspx
Guard your Medicare card information

More info is at theSenior Medicare Patrol Website for Fraud protections

https://www.smpresource.org/Handler.ashx?Item_ID=12B967F4-D379-4337-986A-4D11A8832D8B

Result

The state of New York is cracking down on Hospice providers and California has stopped issuing new licenses. NOT ENOUGH.

Four Senators (Barrasso, Baldwin, Rosen, and Fischer) on Dec 16, 2022 have requested HHS Inspector General step up and investigate the fraud discovered by the New Yorker and ProPublica. Here is a Link to their letter.

There is US Government guidance for hospice providers regarding minimally acceptable standards of care here and there is self reporting but insufficient enforcement other than forfeiture of payments and loss of license. Further inspections, investigations, and in person audits that demonstrate compliance can help. This has to change.

What You Can Do – Contact Legislators

Use Resistbot below or call/email your senators and representative and say

“My name is __________________(name) and I live in __________________(zipcode) and I am your constituent. “We all deserve a healthcare system that works for all of us even when it is time to die. Please sign on to the December 16th 2022 Senator Baldwin letter to the HHS Inspector General asking for a review of the alleged hospice fraud discovered by the New Yorker magazine and ProPublica in November 2022.

Additionally, I want you to press for more hospice audits and inspections of hospices that take Medicare funds and ensure that they meet minimum quality standards. We all deserve this, especially at the end. I’m counting on you.”

Resistbot

Text SIGN PEIWGX to 50409 to send the letter below to your representative and senators.

We all deserve a healthcare system that works for all of us even when it is time to die. Please sign on to the December 16th 2022 Senator Baldwin letter to the HHS Inspector General asking for a review of the alleged hospice fraud discovered by the New Yorker magazine and ProPublica in November 2022.