Sol Davitt
HSA 410
Professor Moore-Ramos
15 July 2013
Hospices Under Federal Scrutiny Investigations by federal agents have found that many hospices, especially in Florida, have systematically billed Medicare for patients not eligible for care or over-billed for “crisis care” that patients did not need. A huge false-billing lawsuit has been launched against Miami-based Vitas Healthcare, one of the nation’s largest hospice providers, accusing the organization of collecting tens of millions of dollars through unjustified and inflated bills (Lamendola). The suit came after four years of investigation in which the government found that eleven smaller hospices had been over-billing. Those hospices had to pay $88 million in settlements. And in January the government joined a lawsuit accusing Hospice of the Comforter near Orlando in phony billings at an estimated $11 million. The federal Inspector General’s office overseeing Medicare has placed hospice overcharges among one of its investigative projects for the year. They have also proposed tightening billing codes that hospices have used to increase Medicare payments six-fold since 1998 (Lamendola). Paul Ledford, executive director of the Florida Hospice & Palliative Care Association says that although hospice has escaped scrutiny over the years, they are getting more attention now. He does not think that hospices in Florida are committing fraud but that instead they are big targets for the government due to the fact that hospices are huge in Florida due to the senior population. Medicare accounts for ninety percent of hospices’ revenue (Lamendola).
Hospices serve patients who are thought to be six months from dying from a terminal illness. They provide palliative care that is designed to ease the pain and make the most of the patient’s remaining time when it is determined that aggressive treatment will not produce a cure. If patients live beyond the six month time frame then the doctor and hospice are required to reassess the patient’s condition to determine if they still qualify for hospice care.
The federal lawsuit states that Vitas routinely signed up patients who were not terminally ill, enrolling them despite the fact that the patients’ own doctors indicated that they did not qualify. In many of the cases Vitas falsely billed Medicare for “crisis care”, which is intensive nursing care during emergencies so patients can remain at home. Crisis care comes with a price tag of $1000 a day in comparison with standard care at $160 a day. The lawsuit states that Vitas paid bonuses to sales staff that enrolled crisis-care patients in large numbers and pressured medical staff to recommend it. As a result, Vitas collected $1 billion in crisis care since 2002, twice as much as all other U.S. hospices combined. Compared with the national average of 1.6 to 1.8 percent in revenue collected for crisis care, Vitas took in fifteen to seventeen percent of its revenue from crisis care (Lamendola).
Vitas has declined to comment on the lawsuit and the only official statement comes from Chemed Corporation which owns Vitas. They deny any wrongdoing and state that they have made significant investments in controls, systems, and procedures to uphold the highest industry standards and to maintain compliance with all regulatory requirements. Compliance efforts are designed to ensure that care is provided only to eligible patients (Lamendola).
Medicare has been looking at hospice care for several years since billing increased from $2.2 billion in 1998 to $12 billion in 2009. Part of the increase was success in getting the word out that beneficiaries can use the service, as more than one million a year now do. But a Medicare report also cites a big jump in patients enrolled with “ill-defined” diagnoses such as debility, a syndrome marked by unexplained weight loss, malnutrition, functional decline, and multiple chronic conditions. By 2009 it was the leading diagnosis with 120,631 cases compared to only 8534 patients in 1998. Similar increases in other diagnosis such as non-Alzheimer’s dementia and “failure to thrive” were seen (Lamendola).
New regulations proposed by Medicare last month would deny payments for debility and failure to thrive without proof of terminal illness. Ledford said the diagnosis are not being misused, they are used when doctors cannot tell what single factor makes a person terminally ill. But health care consultant Reginald Hislop noted that hospice needs to be reformed so that practices evidenced by Vitas can be avoided (Lamendola).
Investigations like these and reform are essential to hold accountable those organizations that allow greed to tarnish the standards of the industry. Integrity, respect, and compassion should be the standards upheld in every single aspect of an organization that is involved in a person’s time in their life that is sadly coming to an end.

Works Cited
Lamendola, Bob. Hospices Under Feds' Microscope. Tampa, 2 July 2013. http://health.wusf.usf.edu/post/hospices-under-feds-microscope.