Understanding Hospice Fraud: What It Is, How to Avoid It, and How to Spot It

Are you and your family falling victim to hospice fraud? In this article, we’ll explore hospice fraud: what it is, how to detect it, and what to do if you suspect you or a loved one is a victim.

Let’s dive in.

What is Hospice Fraud?

The Medicare population deserves access to hospice, however, hospice fraud is a threat to the longevity of this benefit. Every time fraud succeeds, it weakens the program for everyone.

In most cases, hospice fraud occurs when Medicare Part A is falsely billed for any level of hospice care or service, (including when a patient agrees to hospice care, even though they don’t yet qualify for it).

Simply stated, hospice fraud is when Medicare is falsely billed for hospice care services or someone gets enrolled into hospice care illegally.

How to Avoid Scams

First and foremost, anything that sounds too good to be true probably is. Watch out for anyone offering exciting freebies like TVs, recliners, groceries, gift cards, and/or cash. As a rule of thumb, you should never accept gifts in return for hospice services. People making these offers usually have ulterior motives and might be finding ways to exploit your Medicare benefits or enroll you in hospice without your consent.

A general rule of thumb: If you aren’t sure if something is a scam, ask. Don’t hesitate to ask questions and seek clarification.

All of us are vulnerable and may fall victim to a scam from time to time. If it happens to you or someone you love, respond with empathy – the scammer is the one to blame, not you or your loved one. All you need to do is take action to reverse and report the scam to the best of your ability (more on that in the next section).

With that said, there are still some good principles and practices to help you avoid scams in the first place, such as:

Be careful with your Medicare number. Don’t give it to someone offering free services, for example.
Never agree to enroll in hospice in exchange for gifts or perks.
If someone comes to your door and says they’re from Medicare, don’t sign up for services or products (like hospice).

What Does Hospice Fraud Look Like? How To Spot It

Here are some things to look for when trying to determine if you have become a victim of hospice fraud.

False certification of terminal illness. If you or someone you know was falsely certified as terminal, but the normal course of the disease or prognosis exceeded six months.
You or someone you know has been enrolled in hospice without permission.
Your Explanation of Benefits (EOB) or Medicare Summary Notice (MSN) were built at a higher level of care than what was needed and/or what was provided.
You are provided or offered gifts, which can be physical items like televisions, or services like housekeepers or delivery services.
You hear rumors about hospice facilities or specific care workers being suspected of fraud within your vicinity.
Your loved one (or yourself) is kept in hospice for long stints of time you can’t prove are medically necessary.
The surfaces provided by your hospice team are inadequate or incomplete, especially toward the final week of life.
You feel like you have come across marketers trying to sell you service services or products, not medical professionals.
Plans of care or services provided do not include physician certification.

(Source)

How to Report Fraud

If you or a loved one suspect you’ve fallen victim to a hospice fraud scam, contact the California Senior Medicare Patrol at 855-613-7080 or visit CaliforniaSMP.org.

For questions or a professional consultation about end-of-life care, contact California Hospice and Palliative Care Association at 916-925-3770 or visit CalHospice.org.

Closing Thoughts: Understanding Hospice Fraud

Hospice fraud is a real and present danger to Americans and the Medicare system. If you fear you or a loved one have fallen victim to such a scam, report it as soon as possible – even if you aren’t 100% sure.

If you’re providing care for a loved one and want to talk to someone about it, the California Caregiver Resource Centers are here to support you. We are a non-profit network of 11 Centers that support caregivers across the state of California. Every county in the state is covered.