When most people think of hospice care, they think of a person in the very last stages of life going home to die in peace and reflection with the comfort of family and friends around them – as the benefit was originally intended. The reality is that many hospice patients spend difficult and agonizing years “dying” in institutional nursing facilities under the profit-driven watch of dispassionate corporations.

Inspector General Warnings About Fraudulent Nursing Homes & Hospices

The Office of Inspector General of the Department of Health & Human Services (HHS-OIG) recognizes and warns that the intersection of nursing facilities and hospice care raises serious concern for fraud and elder abuse. According to a report by HHS-OIG a number of “potentially illegal practices” have been identified in “a hospice’s access to nursing home patients,” including circumstances where “nursing home operators or hospices may request or offer illegal inducements to influence the selection of a hospice.”

Hospice Care in Nursing Homes: the Double-Billing Conundrum

While it may seem counterintuitive that federally and state-funded healthcare would pay a for-profit corporation simultaneously to provide institutional nursing care and hospice care – that is exactly what happens in many cases. For duel-eligible (Medicaid and Medicare) patients who are certified as terminally ill with less than six months to live, corporations are permitted to bill the taxpayers twice: first for 95% or more of the cost of staying in a nursing institution and second for a flat daily rate for hospice care – even on days where no hospice nurse visits the patient. The patients targeted by such arrangements comprise the nation’s most disenfranchised and most vulnerable citizens: the elderly poor, the category of patients who qualify for both Medicare and  hospice in ventura Medicaid. The potential for profiteering upon such vulnerable patients is exacerbated when the nursing home and hospice are owned by the same company – one company potentially can multiply its payments by billing Medicare and Medicaid for both nursing care and hospice care without supplying any additional services or absorbing any additional costs, all on the taxpayer’s dime and to the patient’s potential detriment.

Potential Patient Harm

It may seem beneficial to the patient to potentially get additional services while in the nursing home – but this is not always the case. If the patient is receiving adequate nursing care in the facility, then hospice care may be superfluous and even potentially dangerous. Because hospice patients must agree to forego any curative treatment, patients who are not truly terminal whom the corporation wrongly certifies as hospice-eligible may not get the important medications, treatments, therapy, and nutrition that they need – even though the taxpayers are being billed twice for the patient’s care. Many hospices even consider dietary supplements like Ensure to be curative treatment and will withhold them from their patients. (It’s no coincidence, though, that such dietary supplements are also expensive and cut into the corporation’s bottom line). Conceivably, if a nursing home patient is inappropriately admitted to hospice, then the otherwise non-terminal patient could slowly starve to death while the company withholds dietary supplements and bills Medicare and Medicaid twice for the patient’s care.