Hospice Fraud

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.

Education Fraud

Each year the government and the states spends billions of dollars on education. Some of this money comes in the form of direct subsidies and some comes in the form of government backed loans. Education is not just big business for charter schools and for profit colleges; even purportedly reputable institutions are establishing new kinds of degree programs which are often no more than income generators.

Many of these institutors know that with government backed loans, they can attract students who will not be thinking about the day that he loan will come due. For unwitting borrowers,  the day of reckoning comes when the loan is due but – in contrast to yesteryear when education was a solid investment —  the return on the newer educational products that are being foisted on the market is not enough to cover the loan.

Students, faculty, and administrators could keep their eyes open for the following:

  • Compensating individuals or entities who recruit students
  • Low graduation rates
  • Low placement or broken promises about placement
  • More than 90 percent dependence on government loans for revenue
  • Misrepresentations as to the educational offerings and the quality of the programs

The U.S. Department of Education (“DOE”) provides billions of dollars in funding to help students participate in education at public, charter, private non-profit, and private for-profit schools.  Education fraud occurs when government dollars have been fraudulently obtained or used in the education sector. In order to receive government funding schools and students must meet and adhere to certain criteria and federally regulated standards. When schools or school employees violate the Higher Education Act (HEA) or other federally regulated standards in order to increase profits they are commiting fraud. 

Education fraud can be very complicated and the types of fraud involved vary greatly. The U.S. Department of Education, Office of Inspector General encourages people to report any suspected fraud or abuse involving education funds or programs.  The perpetrators of violations of Federal regulations pertaining to education programs or funding can include schools, employees, student recipients of funds, contractors, lending institutions, collections agencies, or public officials.  The types of violations that constitute education fraud are just as varied, from predatory loan practices on behalf of lenders to sham university staff positions to misrepresenting student credentials.  

The price of education fraud eventually burdens itself on taxpayers. The Office of Inspector General encourages people to speak up and blow the whistle against fraudulent practices in education that ultimately undercut young people trying to gain access to education.