Hospice is meant to be an end-of-life respite, with a focus on comfort and pain management when people have only a few months, or less, to live. But a jaw-dropping new report from the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services suggests that hospice care for Medicare recipients can sometimes be less haven than hell.
The OIG's analysis of Medicare-covered hospice services — provided to 1.4 million Medicare beneficiaries at a cost of $16.7 billion in 2016 alone — from 2006 to 2016 found that more than 85 percent “had a deficiency” in the quality of the care they provide, while about 20 percent had a serious deficiency (in some cases meaning that the health and safety of beneficiaries may be in jeopardy).
Many recipients were left in “unnecessary pain for many days"; families weren't given crucial information about their loved one's care; and hospices were overbilling Medicare “hundreds of millions of dollars."
But OIG's specific examples illustrate the abuse most vividly. They include a hospice patient who “developed maggots around his feeding tube insertion site"; hospice staff members neglecting to report the possible sexual assault of a beneficiary; and a patient in pain and vomiting blood who wasn't visited by hospice staff for several days.
Then there's the fraud: A hospice billed Medicare for 17 days of general inpatient care for a 70-year-old man, “but never visited him,” the OIG reports. “Instead, the hospice called his family to inquire how he was doing.” Others falsely certified people as terminally ill, offering fake diagnoses. (Some of these hospice owners have ended up in prison.)
The report notes that the current system has led to the typical hospice lowering the quality of its services because Medicare pays it “for every day a beneficiary is in its care, regardless of the quantity or quality of services provided on that day.” It also pays the same for every day of the week, despite often providing fewer services on weekends.
But the OIG certainly doesn't want people to avoid hospice: Deputy Regional Inspector General Nancy Harrison says, “It's an important benefit and can bring great comfort and ease the burden for recipients and their families during a really difficult time. That's what it's supposed to do, and why there are real consequences when the services don't live up to their promises."
To be eligible for hospice, recipients under Medicare Part A must be confirmed as having an illness with a life expectancy of up to six months, with subsequent services focused on comfort rather than cure. Sometimes patients are cared for at home, though they may also be cared for in a hospice facility or hospital.
The use of hospice has grown steadily over the past decade — in 2006 Medicare paid $9.2 billion for fewer than 1 million beneficiaries — and presumably will only increase as the population ages.
The OIG offers a lengthy proposal with 16 specific recommendations to improve the hospice system and Medicare's relationship with it, including strengthening oversight, establishing a consumer-friendly way for families to determine the quality of hospice services and encouraging more physician involvement in patients’ care.
Harrison says the OIG will work with Medicare to offer a way for recipients to compare the quality of hospice programs; right now, she notes, there's a comparison site, Hospice Compare, that allows people to find the programs in their area “but doesn't do nearly enough — you can't see how well a hospice performs,” for one, nor whether complaints have been filed against it.
"There are a lot of really great hospices out there,” she adds. “Let's get that information out to the public."
Responding to the report, Amy Tucci, president and CEO of the Hospice Foundation of America, a nonprofit offering professional development and education about hospice, called the findings “highly disappointing.” She added that while “the vast majority of hospices provide incredible care, many hospices now must improve care to regain the confidence of both the public and the medical profession."
Note: If you do suspect hospice neglect or fraud, the OIG advises contacting your state's department of health and Medicare (plus local law enforcement, if you believe a crime may have been committed). Find out more about Medicare hospice patients’ rights on the OIG site.