Under-Served Patients
Suffer at the Hands of Fraudulent Hospices
Families of terminally ill loved ones commonly report that
some hospices are not providing needed services. Whether it is
needed home health aide visits, inadequate visits by the RN,
refusal to ask the doctor for increased pain medications for
uncontrolled pain, refusal to provide oxygen, or other problems,
the problem remains the same: the patient is not getting what is
needed to manage his or her symptoms. Hospice is all about
providing comfort care, managing the symptoms.
So, when a hospice fails to manage the symptoms or meet the
needs of the patient, the patient and family are confused and
distressed. They ask, "what is hospice about if they
don't meet my loved one's needs?" Yes, what is it
about if the hospice doesn't meet the patient's needs? By
these hospices actions, the only thing it is about is a business
that takes money from the government and then does not provide
needed services for the patients and families that have come to a
hospice for help. Fortunately, not all hospices are perpetrating
this form of fraud. And that is what it is, "fraud,"
plain and simple. Fraud is not only overbilling for services, but
also, under-serving your loved one!
Why would a hospice not provide needed services? Money, money,
and again, money. Those hospices that have integrity do not
under-serve their dying patients. They make sure the
patient's needs are met, to the best of their ability. If the
patient has severe congestive heart failure and needs oxygen, the
RN case manager will use the standing orders to order oxygen for
the patient. If standing orders do not include oxygen, then the
RN will contact the physician and get a doctor's order for
oxygen. If the RN does not get oxygen for a patient who is
severely short of breath, and oxygen would alleviate that
distressing symptom, the RN is violating the standards of care
and her responsibilities under her own nursing license.
Why would an RN refuse to order oxygen, when needed by a
patient? Because hospice management has instructed her not to
provide oxygen and to save money for the hospice. Why would a
hospice not send out home health aides when they are needed? ...
to save money. Why would a hospice reduce the frequency of
nursing visits by the RN to less than what is needed by the
patient? To save money. However, one thing to remember is that
the hospice is collecting money from the government or private
insurer (Medicare, Medicaid, or private insurance company)
specifically for the purpose that the hospice provide the care
needed to meet the patient's needs. Not providing the
services needed is a form of fraud: the government or private
insurer is not getting what they are paying for ... needed
hospice services.
Threatened with Discharge
At the Time of Your Greatest Need?
Some families are reporting that hospices are telling them
that they "have to" discharge their loved one from the
hospice program because the patient hasn't died soon enough!
Isn't this "adding insult to injury," so to speak?
When patients truly have a terminal illness and the physician has
certified the patient as having a terminal illness, then a
hospice cannot discharge the patient when the going gets rough
and care needs increase. Some hospices take the money while
things are easy for the hospice, but discharge the patient when
more visits or medications are required to control the
symptoms.
Misleading Information provided to the Dying
And their Families by Hospice Staff and Managers
When hospice staff go along with management plans to
underserve the dying patients and their families, these staff are
betraying the trust given to them by the public. In order to
under-serve the patients and families, rogue hospices have to
convince patients and families that what the hospice is doing is
"the law" or "normal." So, they misinform the
public about the standards of care.
We receive numerous complaints from the public about how
hospice staff and managers told them that "Medicare
regulations do not allow us to provide ...." and then the
families describe needed services which Medicare mandates that
the hospice actually provide. The hospice had told the families
the exact opposite of what the standards are! When hospice staff
share incorrect information that management has instructed them
to give to the patients and their families, they are violating
their licenses to practice and the regulations governing hospice.
In addition, when hospice staff lie about the standards in order
to commit fraud on behalf of the hospice, they are accomplices to
Medicare fraud and risk being indicted on criminal charges. They
also may be excluded from working in a Medicare funded hospice or
other facility again.
When hospice staff mislead the patients and families, the
patients and families naturally become confused. When they learn
they've been intentionally lied to by the hospice nurse,
social worker and manager, they become extremely distressed and
angry.
Ethical hospice administrators are also infuriated by rogue
hospice administrators and staff who violate the patient's
rights. The ethical hospice administrators and staff cooperate
fully with government enforcement efforts to stop hospice fraud
and deception. Ethical hospice staff and administrators are
distressed by the violation of the rights of needy patients and
also by the tarnished reputation these rogue hospices create for
all hospices.
Ethical hospices have no trouble letting the government
inspectors look at their records (during standard annual or
bi-annual inspections) and speak with patients and families,
because these hospices are doing a good job serving the dying and
their families, and they know they have nothing to hide. Rogue
hospices have much to hide, and they have to lie to cover up
their fraudulent activities.
Hospices That Under-Serve Patients
Violate the Mission of Hospice
Under-serving patients in their hour of greatest need is the
opposite of what hospice is all about. However, it is not so
uncommon or unheard of. Rogue hospices go to great lengths to
excuse themselves and deceive hospice patients and families. They
direct their efforts at getting the families to worry about the
hospice that "can't" provide this service or that
service, for whatever reason, when the fact is, the standards of
care require the hospice to provide those needed
services.
The mission of hospice is to meet the needs of the patients
and their families during the dying process (and provide
bereavement counseling afterwards). Rogue hospices fail to
provide needed care and support to the very patients they are
licensed to serve. They may not under-serve every patient, but
they under-serve many, thereby skimming money fraudulently from
the government.
Rogue Hospices Blame Government
for the Hospice's Problems
Some hospice managers and staff are blaming government
anti-fraud efforts as an excuse for wrongfully discharging
patients. They mislead patients and families by saying that the
patient has to die within six months or the hospice has to
discharge the patient. They say that the hospice will "get
in trouble with the government" if they keep the patient in
hospice. This is absolutely false!
The regulations do not say that the patient "has to die
within six months." The regulations state that the physician
must certify that the patient may die within six
months. This is a statistical probability. Most hospice
patients do actually die within six months, but many terminally
ill patients live longer than the standard "six month"
period. If the patient has the terminal illness and the physician
has certified the patient as having the terminal illness, then no
hospice with integrity will abandon the patient at the time of
his or her greatest need.
While government enforcement of the regulations is imperfect
in some cases, hospices are not being shut down for caring for
patients longer than six months. In some well-publicized cases,
the government inspectors have questioned some hospices that have
provided care longer than six months, even going so far as to
order the hospice to pay back money paid for care beyond the six
months. However, upon administrative appeal, the hospices (who
cared for terminally ill patients beyond six months) have won and
not been punished for legitimate care for the dying. The
government is fighting to get what it is paying for...what the
U.S. taxpayer is paying for.
The United States General Accounting Office estimates that
billions of Medicare dollars are lost each year
to waste, fraud and abuse (this includes all areas of health
care, not just hospice). Of those billions of dollars wrongly
taken by corrupt health care corporations, a significant portion
is taken by rogue hospices that do not operate based upon the
true mission of hospice. Of course, hospitals, nursing homes and
other large facilities perpetrate the largest percentages of
fraud in the health care industry, since hospice is a smaller
segment of the health care industry.
In 1995, in order to combat rampant fraud in the health care
industry, the U.S. government started a project called
"Operation Restore Trust." From 1995 through 1997, the
U.S. Operation Restore Trust project investigating health care
fraud (in just five states) "contributed to the overall
collection of $187 million in fines, recoveries,
settlements, audit disallowances and civil monetary penalties
owed to the federal government." (See the U.S.
Administration on Aging - Anti-Fraud and Abuse Activities Fact Sheet on Operation Restore Trust).
In fact, the government can (and has) recovered millions of
dollars from even one single hospice. But there are over 3,000
hospices in the U.S. The actual fraud committed in the hospice
industry is many, many millions of dollars annually. And when the
government discovers fraudulent schemes by hospices, they order
the hospice to repay the money wrongly taken. They
"settle" and have the hospice agree to comply with the
standards in the future. It is not the practice of the government
to shut down hospices, because the public needs those hospices to
meet their needs. The government forces the rogue hospices to
change their unlawful, criminal behavior and stop defrauding the
U.S. government and its taxpayers.
Some businesses and their administrators have chosen to enter
the hospice field simply because they think it is a good
"business" opportunity to exploit while the Medicare
(and other) moneys are flowing fast. Yes, there are
hospice administrators getting rich at big
"mega-hospices" with many branches (sometimes in more
than one state) while dying patients are not receiving needed
services!
Time magazine (along with other newspapers and magazines) has
documented how some large managed care organization
administrators had received salaries and benefits amounting to
millions of dollars. Some of the largest hospice agency
administrators are also paying themselves extremely large salary
and benefits. These administrators basically control their Board
of Directors who determine the administrators' salaries and
benefits. Could anything be more abominable than exploiting the
dying, the most vulnerable of all, in order to pay oneself
millions of dollars? There would be no anti-fraud efforts by the
government investigating hospices if there were not many hospices
committing fraud amounting to many millions of dollars!
We know that these hospices are committing fraud, because the
State and federal government receive numerous complaints about
these tragic violations of the patients' needs. We also
receive numerous complaints from families all over the nation
about these hospices. The families are devastated, and the
patients are suffering terribly because of the mistreatment by
these rogue hospices. They feel betrayed by the very hospice (and
their staff) that they came to in their hour of deepest need.
Although some hospices wish to complain loudly about
government regulation, honest hospices do their best to provide
care and do not truly have worries about the government. Those
who are worrying are hospices that are committing fraud, and they
complain the loudest, hoping to sway public opinion to influence
government policy and allow them to commit fraud without
government intervention.
One goal of government anti-fraud efforts in this regard, is
to prevent hospices from signing on patients who are not terminal
at all, collecting money without providing hospice services and
defrauding the government. A form of hospice fraud is to sign on
patients who are not terminal, provide little service and collect
money just for signing up these non-terminal patients. If a
patient is truly terminal, no hospice is going to get in trouble
if a patient lives longer than six months.
Need for Families to Advocate
For Their Loved One's Needs
Families report all sorts of "lines" or excuses that
hospice staff and even managers have told them why their loved
one is being under-served or threatened with a wrongful
discharge. If you care about your loved one, do not believe it!
Remember that "the squeaky wheel gets the grease" and
that with today's health care environment, you will have to
stand up to this type of mistreatment and insist that your loved
one get the care he needs to have symptoms under control and
receive the care needed according to his condition. Your concern
as a family member is to see to it that your loved one's
needs are met during the dying process, that she or he is kept
comfortable and that a death with dignity is achieved. You will
need to be an advocate for your loved one, to make sure the
hospice provides what is needed and mandated by the standards of
care.
When a hospice fails to provide needed oxygen, services or
manage symptoms well, they are in violation of the standards of
care governing hospice. When a hospice threatens a patient with
discharge, even though the patient is truly terminal and
suffering, the hospice has seriously violated its reasons for
existing and the most basic requirements of the hospice
regulations. If you have spoken with the RN case manager and
hospice director and still not gotten needed services for your
loved one, then making a complaint to the State inspection agency
and handing a copy to the hospice will often turn things around.
You can make out your own complaint or use the complaint form provided at our website.
|
