Report Faults Medicare for Hospice Conditions, Care

Report Faults Medicare for Hospice Conditions, Care | Pintas & Mullins Law Firm

A patient whose pressure ulcers developed gangrene, resulting in amputation.

A maggot infestation where a feeding tube entered a patient’s abdomen.

A patient whose injuries from a sexual assault were missed and only discovered at a hospital.

These are just a few of the most severe cases cited in a new report on hospice care in America. But while the report by the federal Office of the Inspector General takes Medicare to task for what it describes as weak oversight and enforcement of hospice providers, it acknowledges that Medicare has few tools at its disposal to discipline providers for neglecting or harming patients.

Other than removing hospices from the Medicare program – a step that is rarely taken – Medicare is not permitted to levy fines or other sanctions on poorly performing hospice facilities. There are also few requirements for hospice providers to alert Medicare when they detect violations.

The report goes on to fault Medicare for giving consumers few options for screening hospices for quality or registering complaints. Medicare’s Web portal, for example, does not list hospice provider deficiencies or state inspection results. And while the Centers for Medicare and Medicaid Services (CMS), which is in charge of Medicare, has taken steps to improve the portal, it is prohibited by law from posting inspection reports by private accreditation agencies.

Hospice Care Has Become a Growing Industry

Congress told Medicare to begin reimbursing for hospice care in 1982. Since then, the practice of hospice has steadily become mainstream, which in turn has attracted the attention of for-profit investment and chain ownership.

Today, Medicare pays for most of the hospice care in the U.S., with billings reaching $18 billion in 2017 – double the amount a decade ago. The number of hospices, meanwhile, has risen to more than 4,500.

To qualify for hospice coverage under Medicare, a patient must be terminally ill with a prognosis of living less than six months. As increased numbers of patients with Alzheimer’s disease and other forms of dementia enter hospice, though, many are living far longer than six months, during which their Medicare coverage continues.

Medicare pays providers approximately $200 each day for the first 60 days a patient is in hospice, and about $150 each day after 60 days – regardless of how much care is provided.

What to Do If You Suspect a Problem

While the new Inspector’s General report has helped to shine a spotlight on poor care and conditions in hospices, changes in the law which would allow Medicare to hold hospices accountable seem unlikely to occur anytime soon. It is really up to the individual to make certain the hospice in which a loved one may be spending their final months is providing high-quality care.

If you are unsure about the level of care a hospice is providing or want to hold the provider accountable, contact The Pintas & Mullins Law Firm today at 800-794-0444. Our attorneys have worked with clients who have encountered a wide range of issues in hospice care, and stand ready to help you.