Hospice Medicare Fraud - Health Care Providers Bilking the Patients' Medicare

Fabiola Castillo

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Believe it or not hospices are the one place where you would least likely think that health care providers would bilk the patients and their family members.

Do you have faith in health care professionals? Have you ever thought that the physician or nurse providing health care to you would take an unfair advantage of your situation? What about workers in a hospice?

Not only does fraud occur in a hospice, but it also happens in HMO’s, clinics, nursing homes, and hospitals. Everybody seems to be getting their fair slice of the pie.

In a hospice, many patients and their family members are not cognizant of the fraud taking place. The employees at the facility can be in a state of denial of all the crooked ways going on. If they choose to ignore the mistreatment of the patients, they are just as guilty of abuse as those who commit Medicare fraud.

Examples of Hospice Medicare Fraud

Management at a hospice dictates the total amount of care for in-home health care of patients facing imminent death. They have the power to minimize staff providing such care so that the patient gets a substandard level of care for their condition. This tactic is done to coerce the family to put the patient in a hospice where the cost of health care will skyrocket over home care.

Hospices are notorious for using less than qualified employees to administer care to their patients. Licensed Practical Nurses (LPN’s) perform the same jobs that Registered Nurses (RN’s) should be performing. An RN supervises an LPN just about anywhere across the nation. If there is not enough supervision, the level of care to the patient is less than average. If the hospice chooses to reduce the number of RN’s on their staff in order to save some money, it is the patient who suffers.

The hospice really wants to service the patient under their roof so that they can bill Medicare, Medicaid, or private insurance at a higher rate for nonstop care, which they are not providing. Many people are not aware of all of the rules and regulations governing Medicaid and Medicare, and it is simple for crooked health care providers to send out private bills to the family members who are falsely informed that a particular procedure or drug was only partly covered or not covered at all. Then they will subsequently bill the federal government and the state. Even if they were paid in full, the average Joe will not fully comprehend the billing or what services were performed.

How to Determine if Hospice Fraud is Occurring

Federal law determines the requirements of the level of care that a patients gets. Read up on all the patients’ rights for both hospice and in-home care. Do not allow a substandard level of care determine when your loved one should be moved into a more expensive facility if it is obvious that you are being coerced into making this decision. This should be a red flag for you.

Make sure that your family member is comfortable and receiving adequate pain medication and that the staff is responsive to your family member’s needs. Do not be afraid to voice out your opinion to the RN or person in charge when demanding a higher level of care for your relative. If you feel that your relative is not getting proper care, report your concerns to the state board that licenses and monitors hospices and medical facilities.

There are lots of consumer fraud schemes out there. It is up to you, the patient, to educate yourself to recognize what is and is not legitimate. Hopefully our advice will help you minimize becoming a victim to the crime of Medicare, Medicaid or insurance fraud.

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