Hospice Fraud Attorney
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.
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).
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.