Managing a hospice means taking responsibility for the proper care and treatment of the patients every step of the way. Acts of fraud or negligence can lead to serious consequences for the management of a hospice. Discover the three major types of hospice fraud you should know to avoid problems and provide the highest level of service at all times.
Beware of Billing Fraud
The False Claims Act is meant to deter anyone from trying to defraud any of the government healthcare programs. Anyone can report this fraud, including hospice employees and family members, and loved ones of patients. Plus, the person who reports the fraud will get part of the funds recovered by the government, which motivates people to report acts of billing fraud. Management must consult with an experienced attorney before making any statements regarding potential acts of fraud.
Most false claims in hospices are to Medicaid or Medicare. Lawsuits are costly for hospices, with settlement totaling up to and over one hundred million dollars. One example of a fraudulent claim can be a hospice ordering supplies or medication for a patient who does not really need them. Another example is a hospice asking a patient to pay out-of-pocket expenses that were already reimbursed by Medicaid, Medicare, or a private insurance company. When these acts of fraud are reported, hospices need to answer for them and pay a settlement. Preventing billing fraud helps hospices avoid unnecessary costs and maintain a trusted brand.
Avoid Abuse and Improper Care
One of the most notable acts of fraud committed by hospice teams is the abuse of patients. Studies have revealed up to 80 percent of hospices providing services to Medicare beneficiaries were accused of improper care. Of these facilities, each had at least one deficiency that could support an allegation of fraud against the company. Abusive acts hurt patients and put hospices at risk of facing a costly lawsuit. Consider some examples of improper care that should be avoided to minimize the possibility of being accused of fraud due to abuse.
One example is a hospice reducing the number of visits to a patient’s home, which means giving less care to the patient than required. And, it is considered insufficient to handle treatment on the phone rather than in person. Another situation to consider is how hospices are paid per diem. This payment means they get a fixed amount of money per patient for each day the patient is enrolled at the facility. In essence, this rewards the hospices that provide fewer services to more patients. Other acts to watch are ordering the wrong amounts of medication for patients to save money or allowing licensed practical nurses (LPNs) to perform work they are not allowed or qualified to do.
Consider Kickbacks
When hospices offer an incentive to entities referring patients to the facilities, it can be defined as a kickback. These schemes become expensive for hospices and their partners in these acts. Paying to get patients can lead to accusations of fraud and bring down the reputation of the hospice. The quality of care is compromised when a facility pays to get patients rather than providing the highest level of care to attract them to the hospice.
An example of a kickback is a hospice that gives supplies or other valuable items to a nursing home for referring patients to the facility. Another potentially fraudulent occurrence is providing nursing services to a nursing home that is already getting Medicare payments for such services. Hospices also cannot pay physicians for referring patients. Any of these actions could put the hospice in a position to defend itself against acts of fraud.
Guarding Against Acts of Fraud
Hospice management must be aware of these three significant acts of fraud to ensure the staff does not commit any of them. Ignorance is never a defense, especially when it comes to providing proper care to patients in need. Management must establish a system of checks and balances to verify procedures are followed at all times. Training the staff and monitoring its actions are crucial to prevent fraudulent activity.
Patents and their families rely on the hospice staff to provide care and guidance during a difficult time in their lives. They trust the hospice to handle everything from billing to make a patient’s final moments comfortable. Anything less adds more stress to an already difficult situation. The staff should understand the right way to handle billing, patient care, and patient referrals to eliminate the possibility of being accused of fraud.
Dealing with Acts of Fraud
Staff members who commit acts of fraud must be identified and terminated from employment. Hospices depend on having a trustworthy reputation for attracting patients to the facility. Anything less means the hospice is losing money and could face lawsuits for committing acts of fraud. Patients and their loved ones are vulnerable during these days and rely on the hospice team to take care of everything as they spend their final moments together.
When a hospice is served with a lawsuit, the first step is consulting with a reputable attorney who understands these matters. Usually, the initial consultation is free, and companies find out useful information to move forward successfully. Having an attorney defend the hospice can mean the difference between paying out thousands of dollars and maintaining a trustworthy reputation as a facility patient can depend on.
With a large number of chronic conditions that impact lives, hospices are there to help patients remain comfortable during their final days. Patients and their families depend on the hospice team to handle everything with honesty and care. Anything less makes a troubling time in their lives even more frustrating and difficult. When people are displeased, they take action against the facility.
Training the staff and managing the team closely helps hospices avoid acts of fraud. If a lawsuit is filed, management must consult with an experienced attorney immediately. Avoiding the situation makes it worse and can lead to further accusations of fraud. If your hospice was accused of fraud, you’re not alone. Get legal representation to make things right and continue helping patients for years to come.
