Common Hospice Care Fraud Schemes
- Admission of patients who are not eligible for hospice services
- Improper retention of hospice patients whose health is improving rather than declining
- Payment of kickbacks to nursing homes and hospitals for patient referrals
- Billing for more expensive levels of hospice care when not medically necessary
- Paying bonuses based on the volume of patients admitted
- Falsifying patient charts to justify admission or retention of patients
- Patients staying on hospice care for long periods of time without medical justification
- Failure to conduct required patient re-evaluations
- Admission of patients who do not have a prognosis of six months or less to live
- Inadequate medical records that do not justify admission or retention
Nursing Home Fraud
Hospice fraud can occur in a variety of ways, but none are more worrisome than kickback based relationships between nursing homes and hospices. Nursing homes often enter exclusive or semi-exclusive arrangements with hospices to provide services to their terminally ill patients.
From a financial standpoint, hospices view nursing homes as a sizeable pool of potential patients. In addition, nursing home hospice patients are generally more profitable than hospice patients receiving at-home care.
Hospice staffs also provides patient care, allowing the nursing home to serve more patients with the same or fewer employees. This creates an incentive for some hospice providers to pay kickbacks to nursing home facilities for patient referrals. The result is a growing number of hospice patients who receive hospice care that is not medically and legally proper. Under the Anti-Kickback Statute, it is illegal to “knowingly or willfully solicit, receive, offer or pay anything of value to induce referrals or items or services payable by a federal healthcare program.”
These kickbacks can take a variety of forms:
- Hospice providers supplying nursing homes with free or below fair market value goods or hospice services in exchange for patient referrals
- Hospice facilities referring patients to nursing homes in order to encourage the nursing homes to refer patients back to hospices for care at the appropriate time
Hospice facilities providing free or below market value skilled nursing services to a nursing home, services for which the nursing home is already receiving Medicare payments. The hospice does this with the expectation that when the patient is eligible for hospice care, that hospice company will be contracted to provide hospice services at the nursing home.