Home Health & Hospice Week

Former CMS head has doubts.

Big money is entering the Programs of All-Inclusive Care for the Elderly (PACE) program in the wake of its switch to allowing for-profit providers, and now beneficiaries and providers worry big fraud — or at least abuse — may follow.

When the Centers for Medicare & Medicaid Services changed PACE rules last year to allow for-profit PACE organizations (POs), investors sat up and took notice (see story, p. 333). And one of the big ideas for streamlining PACE care provision —and saving more money/enhancing PO profits — is relying on telemedicine to monitor PACE patients’ care instead of traditional in-person services at the PACE center.

“We understand the need for regulation and strict criteria when caring for seriously ill beneficiaries,” said the National Partnership for Hospice Innovation in its comment letter on the PACE proposed rule. “In hospice, we have seen the proliferation of unscrupulous providers and we do not want to see that experience duplicated in the PACE arena.”

Patients voice similar worries, according to a Kaiser Health News story that ran in the New York Times. One PACE user expressed concerns that new investors will skimp on what outsiders might view as unwarranted services. Another user’s grandson commented that “[a]nytime you involve money, there’s always the concern for greed, especially with the elderly.”

Patients aren’t the only ones concerned. “I’m not wild about every knucklehead running around trying to do PACE,” said former CMS Administrator Tom Scully. “I would rather keep it below the radar,” he told the newspaper.

“For years we were pariahs, and no one wanted anything to do with us,” said Julie Reiskin, executive director of the Colorado Cross-Disability Coalition, a nonprofit group that advocates for people with disabilities, many of whom are eligible for PACE. “Now that there’s money involved,” Reiskin said, “everyone is all interested,” according to the Times.