Hospice Fraud

What are the most common types of Hospice Fraud?

The number one form of Hospice Fraud is admitting patients into a hospice program when they do not Medicare admissions criteria, which that the patients must be terminally ill and have a prognosis of 6 months or less if their disease runs its normal course. 42 CFR 418.20 § 418.20. Related to this is falsely recertifying patients as meeting hospice criteria after the initial admission period ends.

hospice fraud

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To perpetuate this type of billing fraud, hospice operators have forged physician’s signatures on certification forms and/or recorded false symptoms and diagnoses on medical records (which are often created after the fact and backdated). Other forms of Hospice Fraud include: billing for continuous care treatment for patients who do not require round the clock services; paying illegal kickbacks and bonuses to certifying doctors, marketers/patient recruiters, and nursing homes that funnel patients to hospices; and billing for hospice services when patients have left the program (for instance, when they are admitted into a hospital for a condition not related to their terminal illness).


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Indicators of hospice fraud include: (1) unusually high length of stays in the program; (2) abnormally large numbers of “live discharges” from hospice; and excessive cases of non-specific terminal illnesses, such as debility and dementia, combined with smaller numbers of more concrete terminal illnesses, such as aggressive forms of malignant cancers.


 



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