Hospice care in the U.S. has steadily grown over the past 12 years. This end of life care, in which beneficiaries opt out of curative treatment to instead receive palliative care in the final stages of a terminal illness, costs Medicare billions. In fact, Medicare spending went up from $9.2 billion in 2006 to $16.7 billion in 2016 to accommodate the 1.4 million beneficiaries that hospice care serves.
Despite the increased spending to aid terminally ill patients, a report conducted by the Office of Inspector General (OIG) found that oftentimes, a poor level of care is provided, and necessary services are neglected. Additionally, the OIG uncovered fraudulent charges, including instances where hospices charged Medicare for services they never actually provided.
In particular, the report cited poor quality care, lack of information to beneficiaries and their families, inappropriate billing and insufficient services as four main areas in which hospices can improve.
Poor Quality Care
Unfortunately, 9 percent of general inpatient care residents did not receive an appropriate level of physician, nursing or social services in 2012. In fact, it is rare for patients to be seen by a physician at all. Between 2006 and 2016, it remained a common trend that nearly three in four beneficiaries were not seen by a physician.
In addition to insufficient doctoral care, the OIG noted that hospices sometimes failed to create and maintain adequate, detailed and individualized plans of care for patients. In 2012, roughly 85 percent of general inpatient care residents did not have their plans of care met by hospice workers.
Over the past few years, several hospice owners were charged for making fraudulent charges and even falsely enrolling ineligible patients in hospice care. One owner in Mississippi has been excluded from the Medicare program after enrolling people in hospice care without their knowledge and receiving $1 million from Medicare in the process.
Lack of Information to Beneficiaries and Families
Though CMS launched Hospice Compare, a website that allows families to compare the quality of hospices, the OIG accused Medicare of not providing enough information to consumers.
Primarily, Hospice Compare fails to identify any complaints filed against particular hospices. In addition, scarce information is provided regarding quality of care, and no mention of the number, type and severity of problems documented in surveys or investigations can be found anywhere on the website.
Unfortunately, some hospices were found to have billed Medicare twice for the same service, or billing for services the beneficiary did not actually need. The OIG uncovered some hospices inappropriately billing Medicare $447,000 on the low end and $1.2 million on the higher end.
In 2012 alone, Medicare spent $268 million on improperly billed hospital stays for beneficiaries. At times, hospice physicians have also added to the problem by certifying people for hospice that do not truly meet the eligibility requirements for that type of care.
Like nursing homes, hospices were found to greatly lack in the quality of care they provided on weekends. During a typical workweek, 18 to 20 percent of working hours was spent visiting patients. Over the weekend, that number dropped to 4 percent on Saturdays and 3 percent on Sundays.
Even the visits that do occur are fairly short-lived. In 2012, hospice care patients in an Assisted Living Facility only received 4.8 hours of visitation per week from their hospice care worker. Despite the minimal care, hospices still received roughly $1,100 per beneficiary per week from Medicare.
In order to combat these shortcomings, the Office of Inspector General has compiled a list of solutions for Medicare to implement in order to improve the quality of care to some of the most vulnerable in our society. Reportedly, CMS agreed with six of the OIG’s 16 proposals. The additional 10 solutions are being talked through to continually improve the quality of care patients receive.
Near the end of life, care should be nothing short of exceptional. At Jehl Law Group, we have seen and stood alongside families who have experienced traumatic care in the final months of their loved one’s life.
We are committed to seeking justice for those who have suffered at the hands of fraudulence and neglect. If you or someone you know is suffering as a result of poor hospice care or nursing home abuse, please contact us for a free consultation, where we can work alongside you through a difficult time.