COVE: The lethal dangers of hospice care fraud

Hospice care is a special benefit offered to those certified as terminally ill, with a life expectancy of six months or less. But scammers convince Medicare beneficiaries to agree to hospice care even when they do not qualify for it. This scam results in falsely billing Medicare for hospice care and related services and could put you or your loved one’s life in danger.

When patients are enrolled in hospice care (either home care or inpatient care) Medicare reimburses the costs of their treatment daily. Patients who are discovered not to be terminally ill will eventually be discharged from hospice but will have already racked up significant charges billed to Medicare.

A more dangerous aspect of hospice enrollment fraud involves diverting non-terminal patients to hospice care without their knowledge or consent. When patients who have a chance of recovery are diverted to hospice care it quickly leads to their deaths. This is of particular risk when the patient suffers from dementia and is not aware that they are agreeing to hospice care.

There are many red flags that signal possible hospice care fraud and/or abuse. Here are some to look out for:

You or someone you know was falsely certified as being terminally ill (i.e., with a life expectancy of six months or less).

You were offered incentives or gifts to receive hospice care services or to refer friends and family for hospice services

You see on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) that you were billed for a higher level of care than was needed or provided.

You receive incomplete or inadequate hospice care services, or suffered abuse or neglect by a hospice worker.

You notice a separate billing item in your Medicare statement for services that are supposed to be included in the patient’s level of treatment (“double billing”).

If you suspect you or someone you love is the victim of hospice care fraud, contact Vermont Senior Medicare Patrol (SMP) at 802-229-4731 or email cove@vermontelders.org