Fraud And Neglect Are Problems In Hospice Industry, Federal Report Finds : Shots - Health News Medicare pays more than $16 billion a year for hospice services. But a new report from the Department of Health and Human Services says hospice patients don't always get the care they're promised.

HHS Inspector General's Report Finds Flaws And Fraud In U.S. Hospice Care

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Hospice services can offer some peace at the end of life, helping to relieve pain and providing emotional support. But a new government report highlights the ways in which some hospices cheat Medicare and neglect patients. NPR's Ina Jaffe has the story.

INA JAFFE, BYLINE: In 2016, Medicare paid hospice providers $16.7 billion. And hospices are not paid for each individual service. They're paid by the day.

NANCY HARRISON: Regardless of the number of services they provide and regardless of the quality of care they provide.

JAFFE: That's Nancy Harrison. She's a deputy regional inspector general in the Department of Health and Human Services and the lead author of the new report. While patients can generally count on hospice to relieve their suffering, the report shows sometimes patient needs have been ignored.

HARRISON: We found that hospices provide fewer services on the weekends than during the week - far fewer, actually. And patients would have pain on weekends just as well as they have it on weekdays.

JAFFE: The report even found that one hospice billed Medicare without ever visiting the patient. They called his family to find out how he was. Researchers also discovered that some hospice providers appeared to seek out patients in nursing homes or assisted living. Those settings allowed them to bill Medicare for a level of service that some patients didn't need but costs the government almost four times more than basic in-home care. So, Harrison says, in 2012, for example...

HARRISON: That cost Medicare $268 million.

JAFFE: Then there are hospice companies that make money by outright fraud. Department of Health and Human Services special agent Derrick Jackson recalls a case where a Mississippi hospice owner signed up clients who were not terminally ill and didn't qualify for hospice. The owner was sentenced to nearly six years in prison and had to pay back almost $8 million. Jackson says the patients in this case didn't even know they'd enrolled in hospice.

DERRICK JACKSON: Oftentimes, these hospice owners will market themselves as, we will clean your house for free. A lot of times, people just want company. Right? You have elderly folks that no one comes to see them, and they want somebody to come over and sit down and talk with them.

JAFFE: The inspector general's report has 15 recommendations for improving the system. Basically, they say CMS, the Centers for Medicare and Medicaid Services, should analyze more data to ferret out scams and share that information with inspectors and the public. CMS declined NPR's request for an interview. But in a letter to the inspector general, the agency's head, Seema Verma, rejected more than half of the recommendations. CMS also released a statement saying, in part, that the agency is aggressively focused on reducing and eliminating fraud, waste and abuse. Nancy Harrison, the report's lead author, says that it's crucial for the government to get this right.

HARRISON: Because hospice is eventually going to touch us all.

JAFFE: And when that time comes, no one wants it to be harder than necessary.

Ina Jaffe, NPR News.

[POST-BROADCAST CORRECTION: In the audio version of this report, Derrick Jackson is referred to as a special agent with the U.S. Department of Health and Human Services. In fact, his title is special agent in charge.]


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