Following a blockbuster exposé from ProPublica that uncovered fraud and abuse in the end-of-care industry, new reforms from the Centers for Medicare & Medicaid Services that focus on hospice providers have gone into effect.
What is considered an unprecedented overhaul represents the most significant reforms in history.
Shifting focus
The new mandates require inspectors to sample data from numerous locations and broaden their evaluations by incorporating a larger range of metrics. The specific focus is on inpatient care, bereavement practices, and patients who leave the facility alive, a strong sign that patient admissions need to meet eligibility standards.
A particular directive will focus on patient abuse and neglect, a longtime problem based on multiple investigations by media outlets and the Department of Health and Human Services Inspector General’s Office. Apparently, the problem is so widespread; surveyors are under a mandate to look at news reports, prior complaints, and patient reviews.
Even new certified hospices are facing accusations of “gaming the system” and committing fraud by wasting taxpayer money and placing already vulnerable residents in serious danger. Critics are raising questions and concerns about the implementation of hospice benefits and the federal government’s role as a partner.
High-profile help
Industry leaders are banding together, voicing their concerns over the current state of palliative care and the need for more regulations. Trade groups are stepping forward to encourage the creation of “red flat criteria” that would automatically bring additional scrutiny before, not after, hospice owners send bills to Medicare.
Demands are now coming from a House of Representatives bipartisan coalition that sent a public letter to CMS Administrator Chiquita Brooks-LaSure demanding a clampdown on benefit fraud and abuse.
Decisions to place a family member in hospice care are difficult and emotionally charged. Regardless of how long they are in a facility, the highest standards of care and comfort should be the rule, not the exception.
