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What You Need to Know About Medical Insurance Fraud in Hospice Care Before You Blow the Whistle

Medical insurance fraud in hospice is a significant source of whistleblower claims.

medical insurance fraud in hospiceMedical insurance fraud in hospice shouldn’t be a surprise. Fraud can occur anywhere, whether it’s a routine doctor’s visit for a healthy person or hospice care for someone who is terminally ill. Some patients will have private insurance to pay for the costs of hospice care. However, most patients seeking hospice care will pay for it through a government program, such as Medicare, Medicaid or Veteran’s Health Administration.

With the extent government money helps pay for hospice care, it’s not surprising that fraud may occur. Have you witnessed fraud and want to report it? Keep the following information in mind so you fully understand what you’re getting into and what you need to do.

What Is Hospice Care?

The exact definition of hospice care will usually depend on the policies and rules set in place by Medicare and Medicaid. However, generally speaking, hospice care includes emotional support and pain management services for those who have a terminal illness and do not expect to live for more than another six months. In the United States, about two-thirds of patients will receive hospice care services in their home.

Just because hospice care refers to someone who is about to pass away, that doesn’t mean government fraud is any less likely. In fact, it might be a little bit easier because of the increased difficulty of detection.

Why Fraud During Hospice Care May Be Difficult to Detect

One reason why illegal billing may be harder to discover for hospice services is due to the sensitivity of the care. Because hospice care concerns an individual who will very likely pass away soon, it may be more uncomfortable for an individual to speak up when something improper takes place.

For example, let’s say you’re a hospice nurse and you know that your patient should receive six pain pills per day. Because your patient receives his hospice care at home, it’s inevitable that a family member will help provide care, including administration of pain medications. You also know that the bottle containing 48 pain pills should last eight days. However, it runs empty after just seven days. So apparently someone either miscounted the number of tablets in the bottle when filling the prescription, the patient is receiving more pain pills than medically necessary or someone is stealing the pain pills.

A Sad Situation Can Get Worse

Over the next few weeks, you decide to pay extra close attention to the bottle of pain medication. You soon discover that it’s a family member that’s stealing some of the pain pills. They are selling them on the street for cash. They’re trying to help pay for other necessary medical expenses not paid for by Medicare or Medicaid. But the day you finally make this discovery, your patient dies. So confronting the family member stealing the pills is probably a bad idea, at least right now. Also, even if you report the family member, they’re stealing the pills to help pay for other medical expenses for their loved one, not for personal profit.

Is healthcare fraud taking place? Probably. Is this something worth reporting? If you do things by the book, then yes, it is. But if the appropriate action takes place, the family member may have to mourn the loss of their loved one from behind bars. This puts you in a difficult position and makes it much easier to not report it and let it slide.

Another reason why it’s extra hard to find fraud in hospice care is because it often takes place at home. This means several things. First, there are fewer medical professionals around the patient. Second, any necessary paperwork is more likely to be accessible by a family member or non-medical professional. Third, given the home setting, it’s easier to ignore or bend any medical rules and procedures. This doesn’t mean impropriety must take place at home during hospice care, but the potential is there.

What This Means When Serving as a Whistleblower

It may be harder to detect Medicare or Medicaid insurance fraud in a hospice setting. Therefore, you’re taking a bigger risk as a whistleblower. Let’s say you’re not calling attention to the fraud for the potential qui tam reward. You only want to do the right thing. You’re still at a higher risk of looking like a bad person who is trying to drag a family or healthcare provider’s name through the mud.

If it’s harder to detect hospice care fraud, then that will also probably mean it will be harder to obtain evidence of the fraud. The result is that if you blow the whistle on someone, you will have greater difficulty proving fraud. This isn’t always going to be the case. But when you’re debating whether or not to report, it will be something to consider.

Want to Speak with an Attorney Experienced with Medical Insurance Fraud in Hospice?

The above information is just something to think about when blowing the whistle. To make the most informed decision possible, you’ll want to speak with an attorney. Look for one who handles medical insurance fraud in hospice care. Contact our skilled medical insurance fraud attorneys at Bothwell Law Group by calling 770.643.1606 today.

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