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Hospice Fraud ~ New Legislation to Make a Difference

California is leading the nation in serious complaints of hospice fraud, according to a recent Office of Inspector General report. This mirrors our on-the-ground experience at our California Senior Medicare Patrol (SMP) as it currently is the number 2 type of Medicare fraud cases reported.

This is unfortunate for many reasons. One reason is that hospice is an important Medicare benefit. Hospice allows beneficiaries to experience peace, comfort, quality of life and dignity in their final days or months. It provides care focused on pain relief (versus curative treatments), as well as provides spiritual and emotional support for beneficiaries and their family and respite care for caregivers. Yet the fact that it’s misused for fraud can make it harder for beneficiaries to access it when they need it.

The second of many reasons is that beneficiaries who are unknowingly signed up for hospice, can lose access to needed prescriptions, have medical appointments cancelled and/or surgeries postponed, lose access to specialists, and have Medicare deny payment of claims. This is because when on hospice, Medicare does not cover any curative treatments or care. The focus instead is on pain management and quality of life. For beneficiaries who are not terminally ill and are fraudulently enrolled in hospice, suddenly they can find themselves not being able to access the medical care they need. And getting switched off hospice and back onto regular Medicare coverage once a beneficiary becomes aware of what happened is not a fast process.

In sum, hospice fraud, which costs Medicare and taxpayers billions of dollars a year, is not a victimless crime; it harms beneficiaries.

So what can be done?

We encourage beneficiaries and their loved ones to watch out for hospice fraud, know the signs to look for and report any suspicious cases to our California Senior Medicare Patrol. Some tips include:

  • Beware of hospice companies enrolling patients who do not have a terminal illness with 6 months or less to live. Medicare’s hospice benefit is only for those who are terminally ill.
  • Don’t get tricked by hospice companies offering free services such as housekeeping and cooking. Medicare does not pay for this!
  • Watch out for “freebies”, such as bus coupons, medical equipment, food supplements or even payment for enrolling into hospice. These are all scams.
  • Beware of calls or unannounced visits by hospice companies offering additional benefits such as help with cooking and cleaning.

If you or someone you know comes across such scams, report any suspected hospice or other Medicare fraud to our California SMP at 1-855-613-7080.

Legislation efforts to make a difference

With California having some of the highest reports of hospice fraud, legislation is now also being introduced to help stop hospice fraud. Below are two current bills we’re advocating for:

  • SB 664, Hospice licensure: moratorium on new licenses, introduced by Senator Allen, would help stop fraudsters from opening up unneeded hospice agencies. This bill would impose a moratorium on the department issuing new licenses to provide hospice services, unless the applying hospice can show a demonstrable need for hospice services in their area.
  • AB 1280, California Hospice Licensure Act, introduced by Assembly Member Irwin, would prohibit a hospice provider, employed hospice staff, or an agent for the hospice from paying referral sources for the referral of patients to the hospice.

Join us in supporting these bills by contacting your California legislators. And report any suspected fraud to our California SMP at 1-855-613-7080. You can also download and share our Hospice Fraud Alert.