Hospice care is provided under Medicare Part A for persons whose doctor has certified that they are terminally ill and expected to live six months or less, if the disease runs its normal course. The hospice care benefit was considered at a high risk for fraud when the Affordable Care Act (ACA) was passed. To help reduce opportunities for fraud in hospice, the ACA requires documented face-to-face encounters with every hospice patient to determine their continued eligibility.
Hospice Care Fraud Schemes
- Falsely certifying that a patient is terminally ill
- Inflating the level of care beyond what the patient actually needs, such as falsely documenting the patient needs crisis care to receive the highest reimbursement rates
- Providing gifts to beneficiaries to encourage them to agree to a hospice level of care (even though they are also unlikely to be terminally ill)
Report Suspected Fraud
To report suspected fraud, click here.