Home Health & Hospice Week

Fraud problems in Western states are far from fixed, critics say.

This time, a scalding review of California certifications from ProPublica is the trigger. (Hospices may recall that ProPublica has taken credit for at least partially instigating the enhanced oversight procedures for new hospices in Arizona, California, Nevada and Texas, which took effect in July 2023, with its exposé on shady new entrants to the program that it published the previous November.)The nonprofit investigative journalism outlet has once again profiled hospices in California, noting that steps Medicare has taken so far to curb fraud and abuse “have done little to slow the region’s hospice boom.” Centers for Medicare & Medicaid Services “data from last year shows that these four states continued to drive most of the growth of new Medicare-certified hospices in the country, with two-thirds of all certifi­cations taking place there,” ProPublica reports.

That data also shows that CMS “continued to certify hospices located in buildings that have been flagged by auditors and journalists as potential fraud hot spots,” ProPublica says. That includes certifying “15 more hospices at a two-story building in Los Angeles that is home to more than 100 hospices” and “three new hospices last year at a Phoenix address that purportedly houses dozens of providers, all of which have materialized in the past two years,” according to the news outlet.

ProPublica also outlines a case where a patient can’t get in touch with a hospice that appears to have fraudulently enrolled her, and thus has lost access to her usual Medicare benefit services.

Meanwhile, an editorial in the February issue of Scientific American takes the industry to task as well. “As corporate profiteers take over end-of-life care in the U.S., the system is failing many people in their moment of greatest need. Policymakers must better regulate this vital service,” the journal’s editors insist.

“For-profit hospices do a significantly worse job of providing this care than nonprofit agencies do,” the editorial adds. Law- and policymakers need to tighten loopholes allowing bad actors to flourish, the journal charges. That may include transitioning away from a per diem payment model to one based on patient acuity, for example, it suggests.