Jim’s Notebook: Hospice is Sacred Calling, Not Cash Cow

Photo credit: David Clode

I recently had the pleasure of attending a reception at Chicago’s fantastic Shedd Aquarium with a group of nonprofit hospice providers. It was a fun night filled with some great conversations with hospice leaders, coupled with some glasses of a nice cabernet.

Before I share a story from that evening, here’s a reminder to check out my last Inside Hospice post, “In Hospice, Quality is King.”

One of the conversations I had at the aquarium was with Bill Finn, CEO of Reserve Care in Ohio, formerly known as the Hospice of the Western Reserve. As the aquatic creatures of the Amazon swirled around us in their tanks, Bill recounted an experience he had the year prior with direct relevance to the rash of hospice fraud happening in this country.

Kindly, Bill gave me consent to share his story with all of you. Here it is in his own words:

“When I was attending the [National Partnership for Healthcare and Hospice Innovation (NPHI)] conference in Las Vegas last year, I had a very interesting and upsetting discussion with an Uber driver.

Upon hearing that I was attending a hospice conference, the driver exclaimed ‘I’m starting my own hospice! My ex-wife started a hospice, and now she is a millionaire. She hired a doctor who doesn’t see patients but signs anything she needs signed. She is rich! I only need $300,000 to start my hospice, and I am ready to get going.’

When I exited the Uber, I shared that part of my role as the CEO of a community-based, legacy not-for-profit hospice is to protect our community from fraudsters and profiteers. I shared that, if what he described was true, that his ex-wife may very well be committing Medicare fraud, and he would be doing the same.

The gentleman listened, not having any idea of the regulatory requirements, or any notion of quality care or patient service, just thoughts of a get-rich scheme. He pondered my comments, then said, ‘Well, my ex-wife does have a restraining order against me, so maybe I will report her to Medicare for fraud.’

This is a true event which I shared with Kim Brandt, COO of [the U.S. Centers for Medicare & Medicaid Services (CMS)] the same day.”

If you knew how hard I am resisting the urge to devolve into a stream of angry profanities right now, you would be so proud of me. It sickens me to see people who see the sacred work of hospice as a quick way to make a buck while showing absolutely no concerns for the patients they are supposed to be serving.

Likewise, I have to praise Bill’s restraint for not punching the guy. Way to go, Bill.

The exchange that Bill had with the Uber driver elucidates a few issues and raises some questions. First, it provides a look at just how easy it is for fraudulent providers to enter the market and rake in vast sums of money that should be going to support the seriously ill and the dying.

Clearly, we need to strengthen barriers to entry that help prevent bad actors from starting hospices while also ensuring that patients have ample access to care. Balancing those two goals is a complex proposition, but regulators must find a way, be it through a Certificate of Need process or by otherwise strengthening scrutiny of new providers seeking Medicare enrollment.

Regulators also need to take a close look not only at the hospices, but at the physicians who are making these referrals. What do they know about the hospices to which they are sending their patients? What do they understand about hospice fraud and how to spot it? How many are deliberately complicit or taking kickbacks?

It also raises the question of to what extent plain stupidity – or, to be more charitable, ignorance – is contributing to hospice fraud. Like the Uber driver, some of these people may not even understand that what they are doing is illegal, though most probably do. That is not and never can be an excuse, but if this is part of the problem, it must be examined. Perhaps CMS or state agencies should require some type of education for new hospice owners about what constitutes fraud and the consequences they may face when they’re caught.

Such education could potentially help honest providers avoid mistakes that could get them in hot water or adversely affect patients — and hopefully scare some the scammers away.

I would love to hear your thoughts on this. Please send me a note or make a comment.