Literature Review

Van Duyne, Blumenauer, 38 lawmakers push CMS on hospice integrityVanDuyne.house.gov; Press Release; 5/8/24Today, Congresswoman Beth Van Duyne (R-TX) and Congressman Earl Blumenauer (D-OR) led a bipartisan group of 38 lawmakers demanding answers from Centers for Medicare & Medicaid Services (CMS) on the implementation of recent reforms aimed at combatting hospice fraud and abuse. “When electing to receive hospice care, individuals and their families must be confident the provider is committed to delivering individualized, compassionate care that optimizes quality of life; however, we continue to hear about instances of pervasive fraud and abuse,” the lawmakers wrote.  ... To better understand the steps CMS has taken to increase program integrity, the lawmakers continued the letter with detailed questions on the implementation of reforms. Read the full letter here.  ...“Thank you, Representatives Blumenauer and Van Duyne, for your leadership in holding CMS accountable and safeguarding hospice patients and families from fraudulent activities,” said Ben Marcantonio, Interim CEO of the National Hospice and Palliative Care Organization. “Preserving the integrity of the Medicare Hospice Benefit is paramount to ensure high-quality care for Americans with serious illness and end-of-life care needs.” 

Fraudulent hospice providers may be moving between states Hospice News; by Jim Parker; 5/7/24Fraudulent hospices continue to proliferate, and some may be moving between states to escape regulators. Beginning in 2021, numerous reports emerged of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona. Thus far, California is the only state to take action on the issue, including a moratorium on hospice licensing. The U.S. Centers for Medicare & Medicaid Services has also taken steps to bolster program integrity.

[FL] Attorney General Moody announces arrest of two Seminole County residents for Medicaid fraud Office of Attorney General Ashley Moody [Florida]; by Kylie Mason; 4/23/24 Attorney General Ashley Moody’s Medicaid Fraud Control Unit, ... announced the arrest of Debora Behnke and Suman Bhattacharjee ...  [They] ran Pioneer Medical Transportation LLC and submitted fraudulent claims for nonemergency medical transportation for Medicaid recipients, stealing more than $250,000 from the Medicaid program.  "Instead of transporting vulnerable Medicaid recipients, these individuals falsely billed the taxpayer-funded program for services never completed. In some instances, they even convinced patients to move across the state—with no regard for the best interest of the patients—and still charged Medicaid for transporting them from the original, longer distance. ..."

Hospice fraud must be stopped!Hospice Action Network; via email; 4/26/24Across multiple states, the same story is playing out: Criminals are defrauding Medicare, getting licensed and certified to operate as hospices when they have no intent of providing care. This flagrant abuse of vulnerable patients and our healthcare system must be stopped in its tracks. We need your help! Ask your representatives to support a letter demanding answers from CMS. We need as many signatures as possible to keep the pressure on CMS.Take action today!

Support mounts for increased hospice accreditor oversightHospice News; by Holly Vossel; 4/16/24Calls are growing louder in support of increased accreditation organization oversight that could help curb fraudulent activity in the hospice space. In a proposed rule released in February the U.S. Centers for Medicare & Medicaid Services (CMS) introduced a number of provisions aimed at addressing conflicts of interest and establishing more consistent standards, processes and definitions among accreditation entities. The proposed increased oversight would be an important step forward in addressing instances of fraud, waste and abuse in hospice, according to members of the California Hospice and Palliative Care Association (CHAPCA). Regulatory changes such as these would be particularly significant in detecting maleficence in regions like California, which have a rise in program integrity challenges, the organization stated in a recent letter to Congress shared with Hospice News.Notable mentions: Sheila Clark, California Hospice and Palliative Care Association.

Former nursing home CEO gets 2.5 years, must pay $11 million restitution for neglecting payroll taxes McKnights Long-Term Care News, by Josh Henreckson; 4/9/24The former CEO of a healthcare administrative services company was sentenced Friday to 30 months in prison followed by two years of supervised release for failing to pay more than $10 million in payroll taxes at companies he owned. Josef Neuman had been CEO of a Lakewood, NJ, company that provided services to nursing homes and other healthcare providers, including around 20 that Neuman also co-owned. 

How sales and marketing compensation can get hospices into hot waterHospice News, by Holly Vossel; 3/27/24Regulators are taking a closer look at how hospices pay their marketing and outreach workforces to curb fraudulent activity tied to referral streams. Federal and state regulatory agencies have systems in place to detect fraud, waste and abuse in hospice, and some are honing on oversight of sales, marketing and outreach staff payment arrangements, according to Ellen Persons, shareholder at Polsinelli Law Firm. 

Personal care workers received most Medicaid fraud convictions in 2023: OIG McKnights Home Care, by Adam Healy; 3/15/24 More personal care workers were convicted for Medicaid fraud than any other provider type last year, according to a new report released Thursday by the Department of Health and Human Services Office of the Inspector General. OIG found that 279 personal care services (PCS) attendants were convicted of Medicaid fraud in 2023 — far more than the next four highest provider types combined. These convictions amounted to more than $10.5 million in criminal charges. 

California Leads the State-Level Battle Against Hospice Fraud Hospice News, by Jim Parker; 3/13/24As hospice program integrity remains in the spotlight, California remains the only state to take action on curbing the problem. Beginning in 2021, numerous reports emerged of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona. California’s Department of Justice (CDOJ) in 2021 issued a report detailing the state’s history of lax oversight.

Whistleblower cases on the rise nationwide; Sarbanes-Oxley, Dodd-Frank laws open door for more to speak out PressReader, Herald-Tribune; by Esteban Parra and Xerxes Wilson; 3/10/24A former medical director specializing in neurosurgery at southern Delaware's largest health care provider claims in a lawsuit that Bayhealth Medical Center misclassified "brain-dead" patients in order to overbill for services. 

What the UnitedHealth Group Antitrust Investigation means for Amedisys, home health industry Home Health Care News, by Andrew Donlan; 3/1/24 Since the news surfaced Tuesday that the Department of Justice had opened an antitrust investigation into UnitedHealth Group (NYSE: UNH), additional questions have bubbled up. Namely, those questions surround the home health provider Amedisys Inc. (Nasdaq: AMED), which agreed to be acquired by UnitedHealth Group’s Optum in June of last year.

[Updated] CMS crackdown on fraudulent hospice providers in full effect in 2024, expert says McKnights Product Theater, by Adam Healy; 2/22/24In recent years, unscrupulous hospice providers have cropped up in California and other states. In response, the Centers for Medicare & Medicaid Services has prepared a slew of tools to curtail the fraud. States continue to feel the effects. As an example, a California hospice operator last week was convicted in a Medicare fraud scheme for billing nearly $3 million for services that patients did not need, according to the Department of Justice.