The Effect of Hospice Fraud

A hospice firm in rural Alabama used an inappropriate referral process to admit patients, according to a recent article by Ava Kofman which appeared in The New Yorker on December 5, 2022.

Ms Kofman based her article on Marsha Farmer, a hospice employee who solicited patients by attending birthday parties at housing projects, going door to door, following Meals on Wheels deliveries, and identifying potential patients at the American Legion bar. According to the article, Ms Farmer described hospice services as a government benefit which provided medications, equipment, housekeeping, and nursing free of cost while avoiding any mention of death.

Oversight, at least in the southern United States, was not vigorous, as program-integrity specialists tended not to want to be perceived as limiting important end-of-life services. The US Department of Justice did take action against Ms Farmer’s employer, prosecuting the firm under the False Claims Act. The government hired a palliative care expert, Dr Solomon Liao, who reviewed a random sample of more than 200 patients and concluded half of the patients were ineligible for services. Many of the patients who had a decline in function actually had a reversible or treatable disease. At the trial, the physician experts disagreed about the nature of the patients’ conditions, which was not surprising given that prognosticating about end-of-life issues is often very difficult. The government did not prevail in prosecuting the hospice for its fraudulent activities.

The appropriate enrollment of patients into hospice impacts all areas of the health care system. The overutilization of hospital resources for individuals who are unlikely to benefit from invasive and aggressive services provides little benefit to society. Hospice providers who use inappropriate marketing strategies harm the hospice agencies which serve individuals who can benefit of from end-of-life services. A greater focus on who is able to secure a license as a provider as well as the oversight of the delivery of services is clearly necessary.