For-Profit Hospice Facilities More Likely to Overbill Medicare
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Recently, a woman was treated as an in-patient at a for-profit hospice facility for a total of 51 days. The problem? Her symptoms were already well-managed, and she only needed occasional help with eating and taking her medication. Researchers found that there was no need for her to receive around-the-clock medical care at a hospice facility rather than receiving home visits from a hospice professional. Medicare was charged about $30,000 for her seven-week stay.
This is just one of many cases that investigators from the U.S. Department of Health and Human Services have examined in recent years. In a recent study, the department found that some for-profit hospice facilities were billing Medicare almost four times as much as nonprofit hospices. Patients in for-profit facilities were also more likely than those in nonprofit facilities to receive unnecessary care.
HHS also alleges that some hospices are accepting patients who don’t have terminal illnesses simply to profit from their care. It also claims that some facilities are only accepting patients who require extensive medical care so they can bill Medicare more frequently. Additionally, for-profits are charging more for the same services as nonprofits, investigators claim.
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If these allegations are true, they could impact both patients and the Medicare system as a whole. Investigators worry that relatively healthy patients are receiving inappropriate care, such as powerful painkillers that doctors typically prescribe for patients who are close to death. These medicines could negatively impact the health of a patient who doesn’t need them. For example, they might have difficulty communicating their wishes to loved ones or hospice staff. Investigators claim that improper use of some medicines could also cause premature death.
What’s more, improper billing practices have the potential to drain money from the Medicare system — money that is needed for essential care.
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For-profit Hospice vs. Nonprofit
The primary difference between for-profit and nonprofit hospices is that nonprofits don’t pay taxes and cannot show a profit at the end of the fiscal year. They pay their employees and other essential bills, and then redistribute any additional money in various ways (such as donating to charities.) For-profits, on the other hand, can make as much money as they like. They simply need to pay taxes on it at the end of the year. As their names imply, for-profits are in business to make money for their owners and shareholders.
In the future, federal investigators will implement more rigorous inspection of for-profit hospice facilities’ billing practices in order to curb Medicare abuse. Hopefully, this will give all patients access to high-quality hospice care.
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There are other differences between the for-profit and the non-profit hospices. Primarily in the areas of additional psycho-social support. The non profits are more likely to have a more viable volunteer program as well as a more developed bereavement program following the death of that loved one. These are services that are seldom reimbursed by insurances to hospice providers.
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Addendum: not for profit hospices fund raise to support these additional psycho social programs( those mentioned in my previous comments) that enhance support to patients, their families and friends.
It is also important to know that in spite of marketing from the for profit hospices, individuals do have a choice in the hospice program they decide to enroll in. That said, in some of the more rural communities, sometimes there is only one hospice option. But that is not in the case in this Bay area.
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Thanks for your insight Susas! I agree that most nonprofit hospices approach patient care in a far more holistic, patient-centered way. There are certainly some for-profit facilities that do an excellent job of providing for the patient’s physical and psychosocial needs, but, sadly, they are a rarity. People in the Bay Area are fortunate to have a large number of options to choose from. But as you point out, in many parts of the country that’s not the case.
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Thanks for your insight Susan! I agree that most nonprofit hospices approach patient care in a far more holistic, patient-centered way. There are certainly some for-profit facilities that do an excellent job of providing for the patient’s physical and psychosocial needs, but, sadly, they are few and far between. People in the Bay Area are fortunate to have a large number of options to choose from. But as you point out, in many parts of the country that’s not the case.
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