Hospice is a type of health care focused on providing end-of-life care to terminal patients. Yearly, over 1 million patients are admitted to hospice care either in the comfort of their own home or in an inpatient facility. Because of the severity of their condition, hospice is ultimately meant to provide care and comfort to these individuals.
While a sense of duty and compassion is expected from medical professionals, there are unfortunately a significant amount of reported cases regarding hospice fraud in California each year. It is important for patients and medical personnel to understand the tell-tale signs of fraud to prevent it from progressing.
Hospice fraud refers to the unlawful claims made to patients or healthcare systems regarding end-of-life care. The fraud can fall under the categories of billing, abuse, and kickbacks. Some examples of fraud include:
The above are just a few of the many hospice fraud schemes healthcare providers may participate in.
Hospice fraud cases have become a prevalent issue. The State of California in particular, has been struggling in combatting the surge of lawsuits. Earlier this year the State Auditor found there has been the following noted trends:
As evident, the following outlines specific cases of fraud and hospice abuse the state has faced in the past few years.
Recently, a $30 million fraud scheme unfolded in California, with named providers, Saint Mariam Hospice, Inc., and Arcadia Hospice Provider, Inc. The Defendants allegedly were receiving kickbacks for their referrals related to Medicare, and for fraudulent billing. In doing so, the Defendants produced hospice certifications for individuals who did not meet the requirements for care.
Cases like these show intentional manipulation of the financial burdens hospice facilities place on patients and public health systems. Often patients in these facilities require Medicare aid, which when frauded results in funds diverted from others who may need it.
Similarly to financial abuse and fraud, hospice facilities have also engaged in physical neglect or elder abuse. As mentioned above this could be from declination in visits, or it can also be physical harm to the patient. Last year, a hospice nurse was reported for elder abuse when a patient’s condition and open pressure injuries were not properly recorded.
Abuse and neglect can tie into financial fraud, especially when patients are receiving or not receiving care consistent with their pay.
In order to fight the increase in fraud, California has introduced Assembly Bill 1884 which will provide further regulations for hospice facilities. The proposed bill would require inspections of licensed hospice agencies every 3 years, which will be publicly available. It also would enforce “recertification of the terminal illness of a patient be conducted by at least one independent physician in conjunction with the medical director of the hospice or the physician member of the hospice interdisciplinary group.” Ideally, the second set of verification would allow for more fraudulent behaviors to be caught.
This bill would work in conjunction with newly approved Senate Bill 664 and Assembly Bill 1280, which temporarily prohibited new hospice provider licenses and enforced an extensive audit of the state’s licensing and oversight processes. All of these efforts are targeted at decreasing the number of California hospice claims.
Again, working with a California hospice & home health fraud defense lawyer will allow organizations to spot suspicious behavior and ensure proper internal and external action. It is advised that organizations consult legal guidance in ensuring that their protocol is compliant with the State and able to combat fraud before it occurs.
Fraud can be very serious and damaging to a healthcare organization. Facilities or medical personnel who feel they are wrongly accused of hospice care fraud should seek legal representation from a hospice fraud defense lawyer.
Likewise, if you are a healthcare professional seeking to report an individual or facility engaging in hospice fraud cases, it is important to speak with a hospice fraud attorney to understand your role in the legal process.
Fenton Law Group has been a trusted source by medical professionals and the public at large for information pertaining to hospice fraud. To receive an individualized approach and strategic compliance plan, contact our attorneys today at (310) 444-5244 or by filling out a virtual contact form.