Hospice Fraud is not a Dying Industry

Every day in America, thousands of families and friends face end-of-life issues. These loved ones require and deserve special care, support and nurturing at this difficult time. Working in this emotionally charged environment every day is the job of a very special breed of health care provider – our skilled nurses and hospice workers.

Caregivers who work each day with the dying and their loved ones have a unique  blend of compassion and skill. Easing pain and providing spiritual strength are just a few of the things that hospice nurses, aides and clergy do on an every day basis.

Over the last 10 years, the country has seen tremendous growth in both the number and types of skilled nursing and hospice care providers for the elderly. Even in today’s constrained budgetary environment, Medicare and other government health care programs spend billions of dollars each year on hospice care. Unfortunately, the amount spent on hospice care, skilled nursing and assisted living facilities has left the industry open for dishonest companies to commit fraud by enrolling patients that are ineligible for hospice care, upcoding for services, or simply billing Medicare for services that were never provided. In addition to costing taxpayers hundreds of millions every year, this profit-first mentality has a negative effect on the quality of care for our nation’s elderly. Hospice companies and nursing homes that put profit ahead of people are far more likely to provide substandard care that results in patient harm.

Greedy Hospice Care Companies

As a general rule, Medicare requires that a patient be given a prognosis of six months or less to live by two doctors in order to be eligible for hospice care. In an effort to earn more money, greedy and unethical hospice companies occasionally admit patients who have not received this prognosis and are not eligible for hospice care. Dishonest companies view these ineligible patients to be more profitable than patients with six months or less to live because they cut down on patient turnover (they will likely live longer than six months) and will not require as much medical care (they are healthier, relatively speaking, than those with six months or less to live). Despite Medicare rules that require hospice patients to be regularly reevaluated for eligibility, unethical hospice providers still find ways to falsify these evaluations.

Many hospice patients are cared for in a nursing home setting. Nursing homes care for many thousands of our most vulnerable citizens. But just like dishonest hospice facilities, nursing homes occasionally put profit over people, resulting in reduced quality of care. Some nursing homes fail to do the required background checks on new employees, resulting in the hiring of unsuitable and dangerous staff to provide hands-on care for the weak, ill, and the disabled. Other corrupt nursing homes shamelessly cut corners by reducing staff below required levels at the expense of patient care. Bedridden patients are not turned regularly, which causes them to develop terrible and life threatening bedsores. Other helpless patients are not nourished properly and suffer serious malnutrition and dehydration. Not only is this neglect abhorrent, it’s also illegal if nursing homes charge for services that were either insufficient or nonexistent.

Should Nurses Report Hospice Fraud?

The vast majority of skilled nurses in hospice facilities or nursing homes choose their profession because they are compassionate and have a desire to care for those most in need. Likewise, most nursing homes and hospice facilities are ethical and take pride in providing quality care. But some companies do commit hospice fraud, putting profit over people. These corrupt and unethical hospice and nursing home providers need to be held accountable for their actions to stop taxpayer money from being stolen and to help ensure that our nation’s elderly are not neglected, abandoned or abused. This requires nurses and staff with any knowledge of improper or illegal practices to have the courage to come forward and report them. When hospice and nursing home staff blow the whistle on fraud, it sends a message to everyone in the industry that people come first, and that unethical, profit-first actions will not be tolerated.

The attorneys at Baum, Hedlund, Aristei & Goldman understand that caregivers already give so much of themselves in order to take care of our dying loved ones, so it is even more extraordinary when they take on the added responsibility of blowing the whistle on the fraud they see. The truth is these brave whistleblowers are a crucial line of defense at stopping Medicare fraud and abuse.

If you are a nurse or hospice employee that has first-hand knowledge of fraud being perpetuated by your employer, don’t go at it alone. The attorneys at Baum, Hedlund, Aristei & Goldman are ready to help you take this courageous action and to protect your rights every step of the way. In addition to holding these companies accountable for their wrongdoing, hospice whistleblowers that file qui tam lawsuits on the government’s behalf are eligible to receive a reward if their allegations lead to any money recovered.

By | 2017-02-06T23:04:46-07:00 April 9th, 2014|Whistleblower News, Mark H. Schlein|