From Kaiser Health News
A national hospice company improperly cycled patients through nursing homes and hospice with a goal of making as much profit as possible from Medicare, according to a whistleblower lawsuit announced in January.
AseraCare, owned by Golden Living, a national company that provides skilled nursing services and other services as well as hospice, allegedly pressured employees to enroll people into hospice who weren't dying and resisted discharging them despite evidence they weren't deteriorating.
We have written about the turmoil in the hospice industry and some out of control spending. A federal audit has found that Medicare spending on nursing home hospice patients increased by 69% over four years. Medicare spending on hospice patients in nursing facilities jumped from $2.6 billion in 2005 to $4.3 billion in 2009, according to an audit by the Department of Health and Human Services' Office of the Inspector General. The audit found about 58% of increased Medicare outlays were the result of higher enrollment and the length of stay. Additionally, the audit found that hospices with more than two-thirds of their patients in nursing homes earned on average $21,306 per patient, which was $3,182 more than the overall average cost per hospice patient.
Critics of Medicare's hospice benefit have said that the way the government pays providers gives them financial incentives to abuse the system.
The whistleblowers contend that AseraCare first recruited patients eligible for skilled nursing care -also provided by Golden Living-- for 20 days, for which Medicare pays the entire bill. After 20 days, when Medicare requires patients pick up a part of the tab, AseraCare had the nursing homes send the patients to hospice, according to the lawsuit. In hospice, AseraCare would collect a flat payment from Medicare for each day they are enrolled. So essentially they were allegedly trying to maximize the amount of benefit per patient without necessarily doing it for the patient's good.
AseraCare disputed the allegations and said it adhered to all Medicare rules for admitting hospice patients and said it would "vigorously" defend itself against the whistleblower allegations.
The government is joining the whistleblowers' complaint accusing AseraCare of intensely pressuring employees to enroll as many hospice patients as possible, setting high targets. An outside auditor hired by AseraCare in 2007 suggested in a report that the company's personnel policies were affecting clinical decisions, according to the federal complaint.
Of course there are two sides to every story. If the payment system is flawed then people will take advantage of it. So that needs to be fixed. And still people will find loopholes. So then it comes down to the provider side. Unscrupulous providers have always been around. In this case, if the allegations prove true, it would be a blow not just for the company but the industry as Golden Living has enjoyed a pretty good reputation.
But in the end I think many keep forgetting that it is the patient that matters most. If I was put in hospice as a "well" patient, would being in hospice start changing my mindset about how my health is, almost causing a self-fulfilling prophecy of impending death? That is scary to think about yet what would you think if you were suddenly in hospice when you should not have been?
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