Hospice: Last Week Tonight with John Oliver (HBO)
22 Aug 2024 (25 days ago)
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.
- Hospice care originated in England, conceived by Dame Cicely Saunders, an English doctor and social worker. The first American hospice opened in 1974. (00:05:14)
- In 1982, Medicare began covering hospice costs.
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.
- 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.
- 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.
- 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.
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%. (00:13:28)
- 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.
- 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.
- Enrolling in hospice can result in the loss of access to curative care, including chemotherapy, kidney dialysis, mammograms, and life-saving medications.
- Brad Harris, CEO of Nova Health Services in Frisco, Texas, encouraged employees to discharge patients early to reduce the average length of stay.
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. (00:23:37)
- 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.
- Experts suggest that hospices with high live discharge rates should be given particular scrutiny.