Hospice: Last Week Tonight with John Oliver (HBO)

Origins and Evolution of Hospice Care

• Hospice is end-of-life care for terminally ill people who choose not to receive treatment to cure or control their illness. It helps them die comfortably and provides support for their families. (1m7s)
• Hospice care originated in England, conceived by Dame Cicely Saunders, an English doctor and social worker. The first American hospice opened in 1974. (5m14s)
• In 1982, Medicare began covering hospice costs. (5m51s)

Exploitation and Fraud within the Hospice Industry

• Vitas Healthcare was founded by two teachers and Don Gaetz, and was later sold for $46 million to the owner of Roto-Rooter. (6m16s)
• Vitas Healthcare was sued by the Department of Justice in 2013 for billing Medicare for unnecessary crisis care services, resulting in a $75 million settlement without admission of wrongdoing. (10m16s)
• Passages Hospice in Illinois shut down after owner Seth Gilman was indicted and later sentenced to 6.5 years in prison for a $20 million Medicare fraud scheme involving enrolling patients in unnecessary inpatient care. (10m47s)
• A doctor was caught on video accepting kickbacks for referring patients to hospice care who did not require it, highlighting a concerning practice of profiting from unnecessary hospice admissions. (16m32s)

Unethical Enrollment Practices and their Consequences

• Some hospices enroll patients who do not need their care, indicated by a high live discharge rate, with some rates exceeding 70% and even reaching 100%. (13m28s)
• Patricia Marble was kept in hospice care by AseraCare Hospice for five years, despite not needing it, with the company billing Medicare nearly half a million dollars. (15m8s)
• Some hospices have engaged in unethical practices such as enrolling patients without their knowledge, including a pregnant woman in Mississippi who discovered she was enrolled in Revelation Hospice during a doctor's visit. (17m52s)
• Enrolling in hospice can result in the loss of access to curative care, including chemotherapy, kidney dialysis, mammograms, and life-saving medications. (19m3s)
• Brad Harris, CEO of Nova Health Services in Frisco, Texas, encouraged employees to discharge patients early to reduce the average length of stay. (19m52s)

Regulatory Actions and Concerns

• The Centers for Medicare & Medicaid Services (CMS) has revoked the Medicare enrollment of 48 hospices and deactivated the Medicare billing privileges of nearly 500 more. (23m37s)
• California has placed a moratorium on new hospice licenses, but there is concern that bad actors are moving to less regulated states, such as Arizona, Nevada, and Texas. (23m55s)
• Experts suggest that hospices with high live discharge rates should be given particular scrutiny. (24m4s)