Enroll in Hospice & Get a Visa? Newest Trends in Medicare Hospice Fraud

Enroll in Hospice & Get a Visa? Newest Trends in Medicare Hospice Fraud

Have you or a loved one received any of the following offers?

  • “Enroll in hospice and receive free cooking and cleaning! All covered by Medicare!”
  • “Sign up for our hospice program and receive an unlimited supply of shakes & diapers! You don’t have to be terminally ill! “
  • “Did you know older seniors automatically qualify for hospice due to age?”
  • And a new twist….”Enroll in hospice and we can help your loved one obtain a VISA! “

 

If so, say no. It’s a scam. The above statements are all false and misleading used to entice beneficiaries to fraudulently enroll in Medicare’s hospice benefit. The newest twist about offering to help a loved one with a visa came as a recent case to our California Senior Medicare Patrol (SMP).

 

In this case a beneficiary was introduced via her friend’s friend to a hospice social worker. This social worker said if she signed up for hospice, they could also assist her daughter in the Philippines in obtaining a visa. With such a generous offer, the beneficiary immediately signed up.

 

After enrolling, the beneficiary received nurse visits, diapers, pads, and a walker. All seemed fine until the beneficiary had to go to the emergency room. As ER visits are not a covered benefit under Medicare hospice, the claim was denied. This is when the beneficiary’s other daughter, who lives near her mother in California, knew something was wrong.

 

After talking to her mother, the daughter realized her mother had enrolled in hospice but erroneously thought the whole ER trip would automatically disenroll her from hospice and bring her back to regular Medicare. Yet that was not the case.

 

Months later when the beneficiary had an eye surgery, Medicare denied the claim due to “hospice coverage”. With no paperwork trail from her mom to find out what hospice company she was enrolled in, the daughter was unable to cancel her hospice. Finally on one visit to see her mother, a hospice nurse was there. The daughter confronted the nurse and demanded a number for the hospice company. She then called them and insisted they remove her mother from Medicare hospice and not bill Medicare for any more services.

 

The daughter also mentioned the eye surgery bill due to enrollment in hospice. The hospice claimed they could not refund Medicare because they had already rendered services and offered to “take care” of the eye surgery bill.

 

With too many “fishy” things going on, the daughter called our California SMP to report suspected fraud. And yes, this was indeed fraud. The beneficiary does not have a terminal illness, nor did her doctor make a referral for hospice. Hospice also does NOT assist people in obtaining visas for their loved ones. As SMP looked into the case and called Medicare, they identified two hospice companies fraudulently billing for services under this beneficiary’s number.

 

More on the danger of hospice fraud

Fraudulent hospice enrollments are still on the rise and this visa offer is just the newest rendition. Hospice fraud continues to be one of the top three Medicare scams and is dangerous. Not only does it result in millions, if not billions of dollars lost to Medicare fraud, it is harmful and in some cases life-threatening for beneficiaries. For example, beneficiaries can lose access to one’s medications, doctors and/or treatments (such as ER visits in the claim described above), have Medicare deny payment of claims (such as the beneficiary’s eye surgery), have their medications unnecessarily and detrimentally changed, and/or experience a significant decline in health or even death.

 

 

Reminder on what Medicare hospice does cover

Medicare only covers hospice care if a beneficiary is determined by his/her doctor to be terminally ill with 6 months or less to live. If a beneficiary is enrolled in hospice, it changes their Medicare coverage to focus on palliative care, not curative care.

 

How to report hospice fraud

If you or a loved one comes across hospice fraud, just say no, and report it to our California Senior Medicare Patrol (SMP) at 1-855-613-7080.

 

Also, please spread the word about these scams and help empower others to protect themselves and their loved ones. We have a hospice fraud alert available in 9 languages. And we have a recently archived webinar on hospice fraud available online.

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.