New Flavor of Fraud? Hospice hastening death for financial gain.

According to Kuruvilla (2018, May 18), "A former health care executive in Texas has admitted to playing a role in an alleged $60 million Medicare fraud scheme that included disturbing practices such as overdosing hospice patients to “hasten their deaths” and maximize company profits."

Medicare reimburses hospice services on a per diem basis, meaning, the longer a patient is on hospice, the more overall reimbursement an agency will receive. Even on days where hospice staff do not visit a patient, the agency can bill Routine Home Care (RHC). More intense, skilled services, must meet criteria and are subsequently reimbursed at the higher Continuous Home Care (CHC) level. The allegations of hastening hospice patients' death via overdose is counter-intuitive on its face for those of us that follow hospice-related Medicare fraud cases. Ordinarily, Hospice providers encounter challenges in justifying the length of time a patient is on-service, the documentation supporting terminal illness, and correctly calculating the hours associated with the CHC level of care. If the Medicare Hospice Payment System is unfamiliar, a primer can be found here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/hospice_pay_sys_fs.pdf