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How to Spot Hospice Fraud in Nursing Homes

There is evidence of a growing epidemic of hospice fraud and abuse occurring in nursing homes around the country. The topic of “end-of-life” care has been receiving an increasingly alarming amount of attention since about the early 1990’s. Part of the reason it is being scrutinized is the rapid influx of thousands of private businesses that have begun to flood into what was formerly an industry controlled mostly by local, non-profit organizations.

America’s population is currently undergoing a transformation the likes of which no one has ever seen before. It is estimated that as many as 78 million people will cross the age of retirement over the next several years. According to recent statistics, it seems that this has driven investors and business savvy opportunists to the conclusion that there is a lot of money to be made from caring for the elderly. Proof of this is evident when one considers that between 2001 and 2008 the margin of for-profit involvement in hospice care programs exploded by 128% while the tax-exempt sector grew a paltry 1%.

This jump in private interest has begun to set off alarm bells for many watchdog ethicists who believe that the principle motivation of higher profits is interfering with the delivery of proven quality hospice care for individuals who need it. Proprietorships that have the backing of Medicare make an enormous amount of money compared to the earnings of a non-profit. Some claim this is due to less than ethical recruitment practices, whereby nursing homes are being scouted for candidates who can be made to appear in need of hospice, when they are not.

One of the requirements for a person residing in a nursing home to be placed on Medicare-supported hospice care is a prognosis from an attending physician that a terminal condition exist that will end the person’s life within six months. Investigators say that this type of fraudulent behavior is placing an incredible strain on our current health care system as it tries to keep up with the ever-increasing demand for hospice care.

Sadly, most indications suggest that even though more taxpayer money is being spent on end-of-life care, the quality of that care, especially in the private sector is diminishing, and the needs of patients aren’t being met to increase profit margins. A report by the Washington Post suggests that the industry currently generates about $17 billion each year.

How For-Profit Hospice Care Increases Profits

Many agencies will offer incentives to physicians and nurses to provide referrals of patients who may be eligible for hospice care. Some have also been found guilty of billing Medicare for higher levels of care that they never actually perform for their patients.

It is also a common practice to pressure patients who usually would not even consider enrolling in the program. They and move forward with hospice services despite never attaining a physician’s terminal prognosis, which has mentioned, is a legal requirement. The most crucial, and hard to accept method of increasing dividends for their shareholders is just to provide minimal care and poor quality of service to those they are claiming to help.

Other triggers that indicate that less than adequate care is being given in a privately run nursing home, or that Medicare abuses are likely taking place, include:

  • Less money being allotted to care for each patient.
  • There will be no attending nurse engaged in continuing care during the final days of the patients’ life.
  • There will be numerous residents who “outlive” their hospice care program. Administrators often push elderly, and ill patients out of the hospice care program once their care becomes too expensive, or they complain too much about the quality of the care they are receiving.

One significant indication that a company is gaming the system is the obvious lack of training found in the staff employed in the nursing care facility. By hiring less experienced nurses, and poorly training personnel, companies can limit the possibility that one of their employees will become aware of discrepancies and then file a claim of fraud against the agency. Whistleblower programs are becoming a useful tool in fighting back against unscrupulous investment companies who take advantage of the system.

With the help of whistleblowers and educated patients and their families, the instances of fraud and abuse can be limited. Increasingly strict legislation and tighter control over the national health care system as it is used by the private sector is something that is gaining a foothold in the minds of a general public who seem slow responding to this gaping hole in an already struggling health care system.

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