Do You or a Loved One Receive Hospice Care? Tips to Avoid Fraud

Do You or a Loved One Receive Hospice Care? Tips to Avoid Fraud

Hospice is comprehensive care for people who are terminally ill. Hospice includes pain management, counseling, respite care, prescription drugs, inpatient care, and outpatient care, as well as services for the terminally ill person’s family. Understanding the Medicare hospice benefit can help you avoid Medicare fraud while you or your loved one receives the most appropriate care during this difficult time. The tips below are from the Medicare Minutes program.

Step 1: Understand how and when Medicare covers the hospice benefit.

You must meet the following criteria to receive the Medicare hospice benefit:

  • The hospice medical director and your doctor certify that you have a terminal illness, meaning that your life expectancy is six months or less;
  • Elect to have Medicare pay for palliative care treatments; and
  • Receive care from a Medicare-certified hospice agency.

Hospice services are always covered under Original Medicare, even if you had a Medicare Advantage plan before electing hospice.

Choosing to elect hospice is a significant and private decision between you, your family, and your primary care physician. Most hospice providers provide very important and beneficial care to people with Medicare, but a small minority tries to recruit patients who clearly lack a terminal condition.

Beware of any hospice that says it provides curative care or that offers gifts or other payments if you elect to receive hospice.

Step 2: Understand your own or your loved one’s conditions, diagnosis, and care regimen.

Once you start hospice care, you must develop a plan of care with the hospice director and your physician. This plan of care is an important way to ensure that you receive appropriate hospice services.

Under the hospice benefit, Medicare will pay in full for the following: skilled nursing services, skilled therapy services, home health aide services, durable medical equipment (DME), medical social services, pastoral care, nutrition and dietary counseling, and prescription drugs related to pain relief and symptom control for inpatients. If you are a hospice outpatient, you will pay no more than $5 for these drugs.

Remember, the purpose of hospice is to empower the patient at the end of life and help them die with dignity. If you feel that you or a loved one is receiving unnecessary treatments or their needs are not being met, you should speak with your hospice care providers about providing appropriate care. Additionally, you can choose to end hospice care and resume receiving curative treatments for your illness at any time.

Step 3: Review your own or your loved one’s Medicare Summary Notices (MSNs) when they are

Review your Medicare Summary Notices (MSNs) carefully to check that the hospice has billed Medicare properly for services received. One way that hospice providers commit fraud is by inflating the level of care beyond what the patient actually needs. This can include falsely documenting patient needs or billing for additional services while providing a lower level of care.

Take Action: If you notice a prescription you do not take or a service you did not receive listed on your MSN, take action! Speak to your hospice provider to see if there has been a billing mistake. If you don’t get a straight answer or the billing is not corrected, report the hospice provider to your local California Senior Medicare Patrol (SMP) at 855-613-7080.

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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