Hospice Medicare fraud? CEO sets record straight

Nov. 12--Editor's note: A national article on Medicare fraud involving Hospices ran in The Courier-Tribune's Healthy Living section on Nov. 1. Since 2010, the federal government has sought to recover more than $1 billion from Hospices for illegally charging for patients who are nowhere near the end of life. Federal investigators have also been cracking down on Hospice owners and executives for fraud. How dco these actions impact our local Hospice and what checks and balances does the organization have in place to prevent fraud?

ASHEBORO -- "We recently went to talk to a family about Hospice care and they said they would not use us and cited that article as the reason why," said Rhonda Burch Moffitt, president and CEO of Hospice of Randolph County. "Because of the population we take care of, 89 percent are 65 or older and most of those do use Medicare.

"With any business, there is opportunity to exploit clients. Unfortunately, it takes just one instance to hurt all of us."

Has Hospice of Randolph been investigated for abuse of Medicare reimbursement?

"No, to my knowledge, we have not," Moffitt emphatically stated when asked. "We have had corporate compliance in place since 2000 and a Hotline for tips to report anything that a person might think is outside regulations. We have one person who investigates these complaints and, generally, they are from a misunderstanding or not knowing our policies concerning patient care.

"We encourage reporting anything so we can investigate because we can be held accountable."

A check of Office of Inspector General's Department of Health & Human Services, which investigates Medicare fraud, showed no reports of the local Hospice being cited since Moffitt became CEO in 2001.

High standards

In the national article by Encarnacion Pyle, a report from the Office of Inspector General found that some Hospice providers, doctors and staff members have aggressively recruited patients, some of whom do not qualify for services.

"We do not 'seek' out anyone. We get requests from patients, family members and referrals from doctors and hospitals," Moffitt said. "We make sure they are eligible for our services and we do ask if there is a pay source, whether it is private insurance or Medicare. We want to be able to take care of everyone, regardless of how they might pay."

Hospice became a Medicare benefit in 1983 for people with terminal conditions who had six months or less to live.

Medicare pays hospices an average of $154 a day for people with terminal medical problems who receive care at home, the most popular option.

Hospice care is not designed to extend life, so the treatment offered is not intended to cure, but rather to provide comfort. Still, fewer patients have been dying within Medicare's six-month guideline.

David Caughron is the director of marketing and development at Hospice of Randolph.

"Fraudulence in the healthcare system is a national concern and organizations not abiding by rules and regulations should be held accountable," he said.

"As we begin the celebration of National Hospice and Palliative Care Month in November, we want to share information about our organization to reassure this community that Hospice of Randolph County is diligent in holding ourselves to high standards of accountability. We have achieved 'deemed status' with the Centers for Medicare and Medicaid by the Accreditation Commission for Health Care (ACHC). This reflects our dedication to regulatory compliance while providing excellent end-of-life care."

Factors impacting care

The article also said that a Washington Post series in 2014 found that more than one in three patients dropped Hospice services before dying.

Moffitt said any number of factors are involved when a person leaves Hospice care or services.

"People are discharged from Hospice when they might be admitted gravely ill and get better with the expert care we provide," she said. "Of the 5.5 percent of our patients discharged, it is because they stabilize, and decide to try a more aggressive treatment such as surgery or chemotherapy. Unfortunately, they may come back to us later."

Caughron agreed.

"Does everybody die who comes here? No," he said. "Are they discharged? It's true, with specialized care they can improve. It's a misconception -- all discharged are not death."

Hospice of Randolph County rarely has patients stay more than six months that Medicare pays for. Moffitt said that Medicare is set up to pay less the longer a patient is under Hospice care.

The Medicare Payment Advisory Commission is an independent agency that advises Congress on matters involving the federal health care program.

The average length of a stay under Hospice care rose to 86 days in 2011 from 54 days in 2000, MedPAC found -- a period that coincides with an influx of for-profit outfits into the industry.

The number of for-profit hospices nearly doubled from 2000 to 2012, according to MedPAC. By 2013, 3,925 hospices were in operation, up 5.3 percent from the previous year. Of those, about two-thirds were for-profit.

The average length of stay in a for-profit hospice was much longer than a nonprofit in 2013 -- 105 days versus 68 days, MedPAC reported.

At Hospice of Randolph County, 65 percent of its patients received hospice care for one month or less (36 percent of those received care for seven days or less); 89 percent of its patients received hospice care for six months or less; and just 5.5 percent of patients are discharged live from hospice care.

Of greatest concern

"It's a broad brush and not fair to those of us trying to properly do our jobs," Moffitt said. "When you see Hospice Medicare fraud, readers think we are all under the same umbrella. We are not. We are a private not-for-profit hospice and operate under Medicare rules."

Caughron added that the Randolph County agency's greatest concern is to ensure that individuals get the care they need.

"As the article shares, '... only about 40 percent of the people who are deemed eligible for hospice actually use the services.' We are fortunate that in Randolph County we have a slightly higher hospice utilization rate of 50.9 percent. However, there are still many individuals that could benefit from hospice care that never utilize this valuable service.

"The Hospice Medicare Benefit provides hospice care when someone has an anticipated life expectancy of six months or less, yet the majority of those who choose hospice care receive it for a tremendously shorter period of time.

"We appreciate the focus of this article because we too understand the importance of accountability and compliance within healthcare, specifically hospice care."

Hospice of Randolph County's

Myths about Hospice

* Myth: Choosing hospice care means giving up hope.

Truth: Hospice care is the beginning of a new hope ... a hope to make the most out of every moment. We call this "Hospice Hope." We encourage you to take a moment to read the Stories of Hope from our hospice families and learn about the Hospice Hope that our families experience.

* Myth: Hospice care is only for the last days of life.

Truth: Hospice care is most beneficial to those that receive hospice care for longer lengths of time so that they are able to receive medical, emotional and spiritual care. Medicare requires that individuals who receive hospice care must have a terminal illness and their physician must certify a limited life expectancy of six months or less, should the disease run its usual course. However, there is no fixed limit on the amount of time an individual can receive hospice care.

* Myth: Hospice care is only available at home.

Truth: Hospice care is not limited to care in the home. The majority of patients do receive hospice care in their homes, but many receive hospice care in local assisted living facilities and skilled nursing facilities, local hospitals and at the Randolph Hospice House, a specialized in-patient facility.

* Myth: Hospice care is expensive.

Truth: Medicare and Medicaid cover most of your hospice needs; many insurance plans also offer hospice benefits. We work with you and your insurance company to provide the care you need. In addition, Hospice of Randolph turns no one away due to inability to pay.

* Myth: Choosing hospice care means giving up all medical treatment.

Truth: Hospice emphasizes comfort care instead of curative care. Hospice care focuses on pain and symptom management and keeping individuals as comfortable as possible.

* Myth: Hospice care is only for people with cancer.

Truth: Hospice care is available for anyone with a terminal illness and a limited life expectancy of six months or less as required by Medicare regulations.

* Myth: Only a physician can make a hospice referral.

Truth: Anyone can make a hospice referral. You know yourself and your loved ones better than anyone else. If you would like to learn more about hospice care or find out if hospice care can benefit you or your loved ones, please call Hospice of Randolph County at 336-672-9300. Once they talk with you, their first step will be to communicate with your physician to determine eligibility for hospice care.

* Myth: I have to give up my physician when receiving hospice care.

Truth: The hospice team works closely with your physician to meet your care needs.

* Myth: Hospice care is only for the patient.

Truth: Hospice care supports the needs of the patient as well as their family members.

* Myth: Hospice care hastens death.

Truth: Research has shown that in many cases, the opposite is true. A 2007 study published in the Journal of Pain and Symptom Management found that those receiving hospice care live an average 29 days longer than those without hospice care. Some individuals that receive hospice care actually see improved health and are eventually discharged from hospice services because they no longer have a limited life expectancy of six months or less as required by Medicare regulations. However, if the individual experiences decline in their health and becomes eligible for hospice care, they can once again receive hospice services.

* Myth: Hospice care ends when a patient dies.

Truth: Following a patient's death, bereavement and grief support services are available to the family for 13 months or longer if desired. These services are always free of charge and open to the public.

* Myth: I must have a family member that received hospice care with Hospice of Randolph County to receive free grief support and bereavement services.

Truth: Hospice of Randolph County provides free bereavement and grief support services to the general public. Support options include participating in monthly group sessions, attending a private support session and attending a special holiday themed program during the year.

For more information about Hospice services, visit www.hospiceofrandolph.org or call 336-672-9300.

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