Medicare and Medicaid costs in Florida and around the country have risen sharply in recent years, and leading officials at the U.S. Department of Justice believe that fraudulent hospice claims are largely responsible. Hospice fraud is now one of the DOJ’s top priorities, and figures from the Office of the Inspector General reveal why. About a third of the Medicare claims for hospice care submitted in 2012 were billed incorrectly according to the OIG, which cost the federal government $268 million.
OIG investigators looked for health care fraud red flags like patients being released alive when they scrutinized hospice inpatient claims. They discovered cases involving patients receiving hospice care even though they had not been diagnosed with a terminal illness and patients receiving inpatient treatment that they did not need. Hospice fraud has become far more common since the OIG released its report in 2012, which is why the agency has announced that all hospices will be subjected to an eligibility audit in 2023.
Hospice fraud hotspots
An aging population has made providing end-of-life care extremely lucrative. The lure of easy profits has led to a proliferation of for-profit hospices, and many of them are located in California, Texas, Nevada and Arizona. In July 2023, the Centers for Medicare and Medicaid Services announced that all claims submitted by facilities providing end-of-life care in these hospice fraud hotspots would be subjected to medical reviews.
The demand for end-of-life care is expected to increase significantly in the years ahead, which means hospice fraud is likely to become more common. To combat this growing problem, the OIG has announced a nationwide hospice audit, the CMMS is conducting medical reviews of claims submitted by end-of-life facilities located in fraud hotspots and the DOJ is vigorously prosecuting cases involving Medicare and Medicaid fraud.