Are Hospice Providers Misleading Medicare Patients?


There’s no doubting the value of hospice care. It can provide aid and comfort for terminally ill patients and ease the strain on their families. However, it seems some hospice providers may not be as upfront as they should be when it comes to signing up new patients, according to a recent HHS Office of Inspector General report.

One-third of Medicare hospice election statements left out required information, including informing beneficiaries that they're waiving certain Medicare services by selecting hospice care and that hospice care is palliative, not curative. Beneficiaries who select hospice care must file an election statement, which must include details on the hospice benefit.

I spoke with Elizabeth Carder-Thompson, an attorney at Reed Smith LLP in Washington, who said Medicare beneficiaries should be involved in their care and understand the nature of their benefits. “Sometimes families of terminally ill patients are reluctant to be frank with their loved ones about their diagnosis, but nevertheless, the election statement needs to be clear so the beneficiary does understand.”

Carder-Thompson said the report recommended that the Centers for Medicare & Medicaid Services create a model hospice election statement for hospice providers to use when creating their own. She said the model statement would not only help beneficiaries understand their care, but also would reduce the level of discretion given to state surveyors when looking for documentation issues.

The report also found that for 14 percent of general inpatient hospice stays, physicians didn't meet Medicare requirements for certifying the stays, such as writing a short narrative about the beneficiary's diagnosis or including an attestation as to his or her condition. Carder-Thompson said some physicians have been reluctant to prescribe hospice care in the first place, since it would be an admission that they’ve failed to “cure” the patient. This could result in incomplete or missing patient narratives, she said.

However, Carder-Thompson said complete physician paperwork is essential. “It’s in the hospice’s best interests to obtain a clear and well-thought out statement from a physician as to the beneficiary’s condition and the grounds for prescribing the hospice benefit,” she said. Such a statement can provide an effective defense in the event that medical necessity is later questioned by an auditor, or, worse, a false claims case is brought alleging that the hospice is improperly admitting patients who aren’t terminally ill, Carder-Thompson said.

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