Hospice billing ripe for abuse

Hospice care continues to grow and become a large part of the Medicare program, but questionable billing practices regarding hospice providers are mounting, reports the New York Times.

Although one in four Medicare enrollees now use hospice care, the median stay is only 17 days. However, Medicare-related hospice costs have risen from $2.9 billion in 2000 to more than $12 billion in 2009.

Meanwhile, hospice care firms such as Alabama-based SouthernCare, had been taking care of patients in hospice care for years, even though they did not appear to be terminally ill. The company recently settled a federal whistleblower lawsuit for $24.7 million, although it admitted no wrongdoing.

"The financial incentives do in fact dictate behavior," Eugene Goldenberg, a research analyst for BB&T Capital Markets, which follows the hospice industry, told the Times. "It's a lucrative business, at least under the current reimbursement system."

Medicare has recently tightened payment restrictions, requiring declarations from a physician or nurse practitioner every six months that a patient's condition remains terminal. However, some industry experts say that could lead to inappropriate discharge of patients from hospice.

For more:
- read the New York Times article
- here's a statement on the SouthernCare settlement

Suggested Articles

A select few legacy health organizations could thrive under a "Medicare for All" system, according to a new analysis. 

The Congressional Budget Office estimates a Senate package tackling surprise billing and drug prices will save the government $7 billion.

Mahmee, a startup focused on maternal and infant health, just closed a $3 million funding round that includes Mark Cuban and Serena Williams.