Hospice care is defined by the Federal Code of Regulations as a “comprehensive set of services … to provide for the physical, psychosocial, spiritual, and emotional needs of a terminally ill patient and/or family members.” Such end of life care is often provided using taxpayer dollars through federally funded programs such as Medicaid and Medicare. Hospice care through Medicare or Medicaid is available for terminally ill patients with a life expectancy of six months or less if their illness were to run its natural course. In order to receive hospice care a patient must be certified terminally ill by a physician. Hospice care services can be provided in the home or at a nursing home facility and are often accompanied by palliative treatment focused on pain and stress relief. Once a patient elects hospice care they can no longer pursue curative treatments, unless they are under 21 years of age.
What constitutes hospice fraud?
The U.S. Department of Health and Human Services, Office of Inspector General recently audited Medicaid hospice providers and identified a number of transgressions ranging from inappropriate billing resulting in over-payments, poor patient care, submission of claims that did not meet care standards, medical records that did indicate terminal illnesses and providing misinformation to patients and caregivers. When done knowingly these actions would constitute fraud against the federal government and give citizens the right to seek justice on its behalf.