Neglect and fraud have become rampant in home care settings at large. This month, the Office of the Inspector General published a federal report analyzing hospice patient and Medicare payment data dating back to 2005. The report highlighted findings of fraud and neglect as well as serious vulnerabilities in the Medicare hospice program.
Neglect can take many forms. As noted by NPR, many hospices were failing to provide consistent service on the weekends, leaving patients in pain on those days. Furthermore, federal reviewers realized one hospice billed Medicare for high-level care that consisted solely of check-in phone calls with the patient's family. The patient himself was never visited.
Instances of improper payments ranged from to questionable business and billing practices to outright fraud. For example, some hospice providers were targeting patients who live in nursing homes or assisted living. In those settings, the provider is allowed to bill Medicare for a level of service that costs the government significantly more than basic, in-home care. In 2012 alone, Medicare paid $268 million for inpatient hospice care for patients who didn't need it.
In another case, patients who did not have a terminal illness were enrolled in hospice care without their knowledge. These patients believed they were signing up for a free housekeeping service, when in fact they had fallen victim to marketing fraud. When patients are enrolled in hospice care, they forfeit their rights to Medicare coverage for curative care in the future.
Ultimately, the report recommended that the Centers for Medicare and Medicaid Services work to analyze data, identify scams, and share that information with inspectors and the public. This report reiterates the pressing need to improve oversight in home care settings and close loopholes in the system that allow cases of neglect and fraud to continue unchecked.