How Fraudulent Hospices Evade Regulators
Hospice News | By Jim Parker
A slew of fraudulent hospices in California are dodging consequences by shuffling patients around between provider numbers.
That’s according to multiple sources who spoke with Hospice News, expressing their concerns about patterns of fraud continuing even as government regulators crack down on the sector.
Since 2021, numerous media and government reports have emerged of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona. Despite the best efforts of regulators and law enforcement, hospice leaders are concerned that many bad actors are slipping through the cracks.
“As more regulation comes in, it really doesn’t matter. You can give me a regulation right now and in three seconds, I can give you a way to work around it,” a hospice owner told Hospice News on condition of anonymity. “Because I know my industry, I can find a work-around for any regulation … Our systems are filled with loopholes.”
Industry associations also are aware of this issue, according to Logan Hoover, vice president of health policy and government relations at the National Hospice and Palliative Care Organization (NHPCO).
“It is deeply concerning that we continue to see sophisticated fraud attempts in multiple states, targeting beneficiaries and defrauding taxpayers. These deceitful actions reveal that serious vulnerabilities still exist in our system,” Hoover told Hospice News in an email.
One principal tactic among these hospices is maintaining multiple provider numbers, hospice leaders told Hospice News on background. This enables perpetrators of fraud to move patients between the various hospices they own. Another common practice is transferring patients who have reached the payment cap to avoid recoupment.
“I always get agencies that ask me to swap patients with them,” a hospice CEO said. “They say, ‘Maybe we can swap some patients out this way and you can eat into your cap, because my patients don’t have cap space.’”…
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