Hospice Care under Scrutiny

Over the past year, more than 60 cases of fraud have been reported to CMS regarding hospice providers.  One of the biggest complaints – and this has been stated by many home health agency owners – is hospices placing patients on service who don’t need hospice but need home health.  In effect, these early admissions to hospice are causing the death of some patients prematurely.


MedPac statistics agree with home health owners who see hospice as a threat, not a partner in providing care.  In 2000, hospice days of service (DOS) were about 54 days.  In 2011, the most recent statistic year available, DOS for hospice grew to 86 days.  The most startling statistic which is going to create more scrutiny on hospice providers is for profit providers who provide much longer service periods.  For profit providers on average provide 105 days of service, while nonprofit providers only provide 68 days of service.


A recent case in Pennsylvania highlights the current issue pretty well.  The former CEO of Horizons Hospice in Monroeville, PA was charged in federal court with fraud by forcing staff to recruit patients who did not have medical hospice needs.  Allegedly, staff was told to use any method necessary, including walking up to random people at bus stations to solicit services.


What is the real reason for these glaring abuses of the Medicare system?  Lack of clear guidelines.  While no one in the healthcare community should be told or be restricted to provide care, the lack of formal requirements for hospice admissions and timelines are so loose that we have ended up with a system we have now. The current system lacks basic controls to define who is eligible and whether or not their needs are prudent for hospice.  Similar to the F2F and homebound regulations in home health, hospice providers do not face such scrutiny.


Not all hospice providers are in the practice of playing Jack Kavorkian, some do seem to have a focus on their bottom line, not on the patient’s wellbeing.  As more complaints are made, and the media picks up on the consistent abuse, we can expect more scrutiny on hospice providers