Hospices are the one place that you would never consider that individuals or for that matter organizations would consider scamming the patients and their families.
Do you trust your health care providers? Have you ever given any thought to the possibility that your doctor or nurse would take advantage of you and especially those workers in a hospice?
Hospices are the one place that you would never consider that individuals or for that matter organizations would consider scamming the patients and their families. Hospices are not the only health care field where there is some fraud occurring. Hospitals, clinics, nursing homes, HMO’s also can become vultures and take advantage of patients and their families.
Most hospice patients and their families are unaware of the fraud occurring within the hospice. The staff at the facility can easily be in denial of what they see going on and if they turn their heads and ignore the mistreatment of patients they are only adding to this abuse and fraud.
Some examples of Hospice Medicare Fraud in action
Hospice management can manipulate the total amount of care a patient receives for in-home health care of the dying. They cut staff to a minimum so that the patient does not get the correct level of care for their condition. This is done in order to pressure the family to place the patient in a hospice where the cost of care is much more that in home care.
Hospices are infamous for using less qualified individuals to administer the care to their patients. Licensed Practical Nurses (LPN’s) perform functions that Registered Nurses (RN’s) only should be doing. LPN’s must be supervised by a RN in almost every state. When there is not adequate supervision the care is not what it will be with it. If the Hospice reduces RN staff in their facility in order to cut costs it is the patient who suffers.
The hospice of course wants to have the patient in house so that they can bill higher rate for continuous round the clock care (that they are most likely not providing) and they will bill Medicare, Medicaid from the states and private insurance for a maximum level of care. Medicaid, Medicare and Insurance fraud are another form of frauds all together. Most individuals are not cognizant of all of the rules and regulations governing Medicaid and Medicare, and it is easy for unscrupulous operations to also private bill the families stating that a particular drug or procedure was only partially covered or not covered at all and then go on to bill for it again through the federal government and state. Even if they receive all of the statements the average person will not understand the billing and what or if the procedure was actually performed. If the patient has already passed they will not even be able to question it.
How to detect Hospice Medicare Fraud and what to do about it
Law dictates the requirements of the level of care a patient needs. Find out all of the patients rights for both in-home care and hospice facility care. Do not let an inadequate level of care dictate when your loved one should be moved into a more costly facility if it is obvious you are being pressured to do this. The will be the most obvious red flag.
Make sure your loved one is comfortable, has adequate pain medication and the staff are responsive to their needs when is a facility. Do not be afraid to demand a higher level of care by bringing your concerns to the floor supervisor or the RN in charge and if this does not do anything to relieve your anxiety then speak to the administrator of the facility. If the problem continues then report your concerns to the specific department in your state that licenses and monitors hospice and medical facility care.