New Federal Report Reveals Fraud, Lack of Oversight and Poor Care for Patients

A new federal report from the Office of Inspector General (OIG) is calling on regulators to increase oversight of the hospice industry, which served 1.4 million Americans and received $16.7 billion in Medicare payments in 2016.

The report details fraud schemes and inadequate care for patients, with some hospice residents experiencing uncontrolled pain or respiratory distress for more than two weeks.

If your loved one was neglected or victimized by fraud while in hospice care, you may have legal options. Contact a Milwaukee nursing home abuse lawyer at our firm for a free legal consultation. We do not charge upfront fees and do not charge for our services unless you are compensated.

Poor Care in Hospice Facilities

Medicare provides hospice benefits for elderly patients designed to help them live their final days in peace and comfort. This often occurs in the place where the patient already lives, such as his or her home, nursing home or assisted living facility.

Medicare pays for agencies to dispatch aides, social workers, chaplains and nurses who agree not to try to cure the terminal illness. Instead, they provide care to help make the patient more comfortable.

Unfortunately, the OIG report reveals disturbing gaps in care for hospice patients. For example, in 2016, 665 hospices provided only basic care, which is a red flag. Under Medicare requirements, hospices must provide continuous care in a crisis, respite care to provide temporary relief for a caregiver, and general care for acute issues like uncontrolled pain.

This resulted in numerous incidents of residents not receiving appropriate care. For instance, an 89-year-old man suffered from uncontrolled respiratory distress for 14 days.

Some patients received fewer services than were promised in their plans of care. The OIG report says this is significant because hospices create their own care plans for each patient and they did not provide what they said they would.

The OIG report also highlighted the fact that hospices provided an average of 4.8 hours of visits per week, even though they received $1,100 per week in Medicare payments.

The types of gaps in care highlighted in this report were also identified in last year’s report from Kaiser Health News. This investigation found that hundreds of hospice facilities fell short in their obligations and were not providing services that had been promised.  

Fraud in the Hospice Industry

Another disturbing aspect of the hospice industry is fraud. The government report uncovered inappropriate billing and recruiters going door to door to pitch fraudulent schemes. The goal of these schemes was to lure healthy patients into hospice care in exchange for free medicine and housecleaning.

This is why the OIG report asks the Centers for Medicare & Medicaid Services (CMS) to take 15 different steps to improve oversight of the industry. For example, the report says CMS should tie payment to the quality of care and put inspection reports on its website.

Contact a Nursing Home Abuse Lawyer

Do you have a loved one in hospice who has been neglected?

Contact an attorney to discuss your situation in a free, no obligation legal consultation. The trusted lawyers at PKSD can review what happened to determine your legal options.

If you have grounds for a case, we are ready to aggressively pursue the fair compensation you deserve.

Complete a Free Case Evaluation form or call us at 414-333-3333 .