For 14 days, an 89-year-old with respiratory problems went without proper control of his symptoms. The patient experienced respiratory distress and anxiety. Another patient with dementia spent more than two weeks with uncontrolled pain. The patient's pain medication wasn't updated until day 16. It took a week for a special bed for this patient to be provided
These distressing patient stories share two similarities: Both were Medicare recipients and both were in hospice care. Unfortunately, these are just a few of the stories of poor care and outright fraud suffered by Medicare recipients facing the end of life and requiring no more than death with dignity.
The number of hospices in the U.S. increased by 43 percent between 2006 and 2016, but so has the Medicare fraud, and it's affecting millions of people. The majority are for-profit hospices, which typically house patients 26 days longer than nonprofit hospices, and make $4,000 more because of the difference, according to a report released this week from the Inspector General's office at the U.S. Department of Health and Human Services.
The amount of Medicare beneficiaries receiving hospice care increased by about 53 percent between 2006 and 2016, with 1.4 million Medicare beneficiaries receiving hospice care in 2016.Spending increased by 81 percent within the same time frame — 2016 medicare spending for hospice care was $16.7 billion.
Medicare fraud costs the government tens of billions annually
Medicare fraud is a huge problem. The program spends more than $600 billion a year on health care for tens of millions of seniors, with fraud and inappropriate billing reaching as high as $60 billion a year. That amount is almost twice as much as the National Institutes of Health spends on medical research each year.
Even when fraud is not an issue, the rising spending on hospice services does not mean patients facing the end of life are actually receiving the proper care. Home hospices provide less than five hours of visits each week, and even less on the weekends. Of hospice beneficiaries in nursing facilities, hospices provided "fewer services than outlined" for 31 percent of claims, the HHS Inspector General's report found. Hospices also failed to provide "nursing, physician, or medical social services" for 9 percent of general inpatient care stays in 2012, according to the report.
Care planning, a "crucial" element of hospices services that outlines the scope and frequency of visits needed, is also failing. Hospices did not meet plan of care requirements in 85 percent of general inpatient care stays in 2012, the report found.