By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    physical health
    5 Ways Playing Games Can Improve Neural and Physical Health
    September 9, 2022
    Reasons For Hair Loss and Its Treatment
    Reasons For Hair Loss and Its Treatment
    February 16, 2022
    healthcare organization
    5 Actionable Strategies For Healthcare Organizations
    August 15, 2022
    Latest News
    Beyond Nutrition: Everyday Foods That Support Whole-Body Health
    June 15, 2025
    The Wide-Ranging Benefits of Magnesium Supplements
    June 11, 2025
    The Best Home Remedies for Migraines
    June 5, 2025
    The Hidden Impact Of Stress On Your Body’s Alignment And Balance
    May 22, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    The Latest Numbers on Exchange Enrollment
    January 20, 2014
    conversational AI in healthcare
    How Conversational AI is Making Healthcare More Patient-Centric
    July 24, 2024
    create tracking metrics HIS
    Create Tracking Metrics for ICD-10 Preparation
    February 18, 2014
    Latest News
    Let Your Lawyer Handle the Work Before You Pay Medical Costs
    July 6, 2025
    Top HIPAA-Compliant Messaging Apps for Healthcare Teams
    June 25, 2025
    When Healthcare Ends, the Legal Process Begins: What Families Should Know About Probate and Medical Estates
    June 20, 2025
    Preventing Contamination In Healthcare Facilities Starts With Hygiene
    June 15, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Hospice Fraud on the Rise
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Public Health > Hospice Fraud on the Rise
BusinessPolicy & LawPublic Health

Hospice Fraud on the Rise

MichaelDouglas1
MichaelDouglas1
Share
6 Min Read
hospice as a business
SHARE

hospice as a business

hospice as a business

Medicine is becoming increasingly fragmented. Sure, the discipline of medical care hans’t changed, but the way in which delivery is packaged and sold to healthcare consumers (formerly known as patients) is a rapidly evolving concept. In the late twentieth century, burgeoning systematic growth in managed care fundamentally altered payment schemes by weighing remibursements based upon arbitrary metrics (RBRVUs, etc.). Within the scope of primary care, this meant that phsyicians could no longer have the freedom bill services in a uniform manner. Capitation models, for example, were being systematically shunned in some regions in favor of relative value units.

Acute care models were favored with potentially higher payments to physicians and hospitals over ambulatory, preventive care. The hospitalist specialty was likely a consequence, carefully being crafted by its proponents and initially nurtured as a niche delivery, evolving to an essential part of streamlined care process. Unsurprisingly, growth gave way to governance, spawning specialty boards, national associations, and specialty journals. The same could be said about the growth of the hospice “industry” — as the mainstream media likes to call it. Hospice medicine — delivery of care to actively dying patient — has steadily transformed from an earnest provision of unique care to this type of patient to an additional revenue stream for (mainly) profit-driven entities. Over the past 35 years, the move to adopt hospice care as a fully accredited mode of care delivery picked up steam with political support. Congressionally mandated government demonstration projects confirmed the need for this level of specialized care, and by the late 1980s, hospice medicine became an essential part of the care continuum in this country, complete with a special benefit status within CMS (formerly HCFA).

More Read

Image
Mobile Health Around the Globe: India – Using eCompliance to Control Tuberculosis
Failing Grade for Health IT in Medical School?
5 Steps to a Successful Physician Marketing Plan
Value-Based Purchasing Must Bring Healthcare Providers & Vendors Together
5 Benefits of Revenue Cycle Management (RCM) in Healthcare

All of the growth that hospice models of care have demonstrated over the past two decades has wrought an unfortunate consequence, however. The specter of fraud and abuse became harsh realities for the federal government, forcing the need for increased government oversight. Questionable certifications for terminal illnesses led to reforms that strengthened the Medicare Hospice Benefit, essentially codified into law as part of the Omnibus Budgetary Reconciliation Act of 1997 (legislation that also reformed and revolutionized care delivery in nursing homes). With greater publicity surrounding hospice medical delivery at the turn of the 21st century, came opportunities for third party care providers to capitalize upon increased lay awareness. Essentially, a nidus of small, mostly religious-affiliated organizations that provided such services has mushroomed into a multi-billion dollar industry, led by national chains — many of which aggressively market their services. As these sheer numbers have exploded, it has been increasingly difficult for regulation to occur, laying the groundwork for further fraud — and patient harm, by extension. HuffPo has a nice feature on “Hospice, Inc.”, which is well worth the read.

Every day, hospice marketers descend on doctor’s offices, rehab centers and hospitals. These workers have been known to rifle through patient logs at nursing stations, scramble to sign up what some in the industry call “last gasp” patients — people with just hours left to live — and even scuffle with each other in hospital corridors over the right to sign up dying people, according to current and former hospice employees and allegations made in federal lawsuits.

Since 2006, the Justice Department has sued more than a dozen hospice companies for going too far in the pursuit of patients. The roster of companies accused of billing fraud includes Miami-based Vitas, the largest hospice provider in the nation. Prosecutors accuse these companies of overbilling for care that isn’t required, refusing to discharge patients who improve and enrolling people who aren’t dying.

The payouts to organizations that deliver hospice care are rather consistent and generous, as CMS incentivizes enrollment with payments that are typical of a stable, daily rate, with increases based upon patient severity and multiple diagnoses and complexities.

Hospice executives maintain they aren’t swayed by these monetary rewards, and that the vast majority of their patients are appropriate for the service and satisfied with the care. They argue that because doctors must sign off on enrollments, proper medical oversight exists to prevent fraud.

Burgeoning growth of for-profit organizations; increasing numbers of patients who are sicker, longer; lack of transparency of many of these organizations; and the glacial pace of federal attention to this issue have all combined to create a crisis for cost-containment, appropriate care delivery, and unforeseen abuses in a care discipline which has its moral and righteous roots in one of the noblest professions. | LINK

Hospice industry (image source)

TAGGED:hospice
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

car accident lawsuit
Let Your Lawyer Handle the Work Before You Pay Medical Costs
Policy & Law
July 6, 2025
women dental care
What Is a Smile Makeover and How Much Does It Cost?
Dental health
June 30, 2025
HIPAA-Compliant Messaging Apps
Top HIPAA-Compliant Messaging Apps for Healthcare Teams
Global Healthcare Policy & Law Technology
June 25, 2025
recovering from injury
Rebuilding After Injury: Path to Physical and Emotional Recovery
News
June 22, 2025

You Might also Like

Business

Are Market-Oriented Economists Wrong About Health Care?

March 16, 2011

Healthcare Reform and The Cost of Prescription Drugs: Price Gouging or Providing Hope?

December 15, 2012
planning is crucial for running a healthcare business
Business

Important Considerations when Starting a Healthcare Business

June 1, 2021

Irrational Attitudes Toward Risk

June 3, 2011
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?