Hospice Elder Abuse Is On The Rise
A recent article in the LA Times reported on an issue Berberian Ain is all too familiar with: Hospice-centered elder abuse is on the rise. While we’ve written a lot about the type of elder abuse that occurs at nursing homes in this space, elder abuse in hospice care is a serious issue that the state of California is seeing more examples of in recent years. The reason? According to Michael Connors, a patient-care advocate with California Advocates for Nursing Home Reform, it’s the lack of accountability.
“Hospices are so poorly regulated in California, and Medicare dollars are so lucrative, that a lot of companies are trying to cash in,” Connors said. “There is no meaningful regulatory oversight whatsoever in California.”
Hospice fraud and abuse is not a new phenomenon, but the recent growth of the Hospice business community combined with the Covid crisis has led to stress on the regulatory measures put in place to prevent it. In the last decade, “LA County’s hospices have multiplied sixfold and now account for more than half of the state’s roughly 1,200 Medicare-certified providers”, according to a LA Times analysis of federal healthcare data.
The San Fernando Valley now has the highest concentration of hospices in the nation.
California also leads the nation in violations for enrolling patients without medical proof they were terminally ill, while having the lowest barriers for entry in the hospice-care market. This means that while the issue is now getting national attention, it will not abate any time soon.
Elderly patients in hospice care have rights too. While patronage of a hospice is intended to be temporary, that does not negate any of the laws set in place to protect the elderly from fraud and harm.
What Is Hospice Care?
Hospice care, or palliative care, is the term used to describe the care given to help alleviate the pain and distress of a patient that is determined to be terminal as they spend their last days. The availability of hospice services can provide solace to both the patient and the patient’s family, supplying a steady, knowledgeable expertise in a field people rarely wish to explore.
Usually when we think of hospice care we picture an assisted living facility, but hospices offer other palliative alternatives. A hospice can provide prescription drugs, spiritual care, medical equipment and supplies, nursing care ranging from around the clock to spot visits. Some hospices also offer education to relatives of the elderly, letting the family provide the palliative care.
The U.S. hospice industry took root in the mid-1970s but flourished only after Medicare began covering its services in 1983. In 2018, 1.55 million patients were registered in hospices in America, and spent an average of just over two months in hospice care.
Hospice Fraud and Abuse
In 2018, it was determined that as much as 10% of the $600 billion spent on Medicare costs was fraudulent. A large portion of that has come in the form of for-profit hospices taking advantage of lax and sometimes non-existent oversight in three key areas:
- Kickbacks for references – A hospice offers incentive to a doctor or nurse to refer a patient to hospice care despite the patient not actually qualifying. For-profit hospices have patients for 40% longer than in a nonprofit hospice, meaning they likely didn’t qualify for hospice care in the first place.
- Overcharging levels of care – Hospices charge patients out of pocket expenses for items (such as medications, or equipment) that are covered by Medicaid, or charge patients for full care services while providing a nurse only a few hours a week.
- Billing fraud – This includes ordering unnecessary Medicare-billable services for a patient, not discharging a patient that recovers, or even keeping patients alive longer than is responsible to continue billing for their service.
How Can I Protect My Loved One Against Hospice Care Fraud and Neglect?
Absent major changes in the system, consumers shopping for a hospice in their neighborhood might never know about serious problems uncovered by state and federal regulators.
As the LA Times article notes, while licensing and inspection reports compiled by the state — sanitized of key information, such as the names of hospice employees and doctors — are available to the public and include details of violations and corrective action plans, “inspection reports written by the accreditation agencies that oversee the vast majority of California hospices are not publicly disclosed.”
This can make it difficult to determine if a potential hospice facility has been delinquent in their responsibilities to their patients. Here are some things to consider.
- Are they accredited? While accreditation is not mandated by the state, some hospices will seek accreditation to prove their credentials. Look for a hospice that has a Palliative Certification from the Community Health Accreditation Partner (CHAP) or The Joint Commission.
- How long have they been in business? Longevity isn’t the strongest guiding light of a company’s legitimacy, but it does lend it credibility. Finding a hospice that has a track record of responsible care goes a long way towards feeling confident placing your elderly loved one under their guidance.
- Where are they ranked on Hospice Compare? Medicare released a tool for comparing hospice providers based on health inspections, staffing, and quality of resident care measures. Use the tool to look up the best hospice care facility in any zip code.
Can Hospice Caregivers Be Charged With Neglect?
Yes. If you or a loved one have already been victimized by a negligent hospice caregiver, you do have recourse. Just because a hospice patient is terminally ill does not mean wrongful death claims can’t be levied against a hospice. Hospice patients are afforded the same rights as the non-hospice elderly. They have the right to not be defrauded, harmed, or neglected in hospice care.
If you or a loved one have been the victims of, or witness to, hospice fraud or abuse, please contact us for a free consultation. Berberian Ain LLP is committed to achieving justice for anyone who has been harmed by a hospice or elderly care facility. Let us help you.