What is hospice?

Hospice is designed to help patients with a terminal illness with symptom control, maintaining comfort, and pain management. Hospice services are focused on caring for the patient towards the end of their life, rather than curing their condition/disease. Hospice will also provide support to the patient’s family and caregivers.

Hospice is optional for patients, not required, but there are certain qualifications for hospice benefits under Medicare. The patient must be enrolled in Medicare Part A and the patient’s doctor must certify that the patient’s life expectancy is six months or less. The patient can only stay in hospice longer than six months if their doctor recertifies that they are still terminally ill. The patient can also opt out of hospice at any time. For instance, if their health improves or their illness goes into remission, they may not need hospice care anymore.

You can visit the Medicare website for more information about hospice benefits under Medicare.

What is hospice fraud? Why is hospice fraud dangerous?

Unfortunately, scammers have found ways to falsely bill Medicare Part A for hospice care or services that were not received. This is known as hospice fraud.

Hospice fraud is dangerous to beneficiaries for many reasons. Because hospice focuses on comfort care rather than treating the condition, if a beneficiary switches to hospice, their curative care (for example, chemotherapy) is no longer covered. With the patient being unable to receive lifesaving or curative treatment, their health might suffer greatly. Like we mentioned above, you can opt out of hospice at any time, but when you’re dealing with a fraudster, you might have a harder time (or a longer wait) in receiving the care you need.

What are some common hospice scams?

Some common hospice scams include:

• Getting beneficiaries to agree to hospice care even though they do not qualify (for example, fraudulently certifying patients who are not terminally ill)
• Enrolling patients in hospice without the patient’s permission or knowledge
• Giving gifts or other incentives to physicians or nursing homes for referring patients to hospice
• Giving gifts or other incentives so patients elect hospice even if they are not qualified (or incentives for referring friends and family to hospice)
• Keeping patients on hospice for a long period of time without medical justification
• Billing Medicare for a higher level of care than the patient needed (or billing for incomplete/inadequate care or services not provided)
• Disregarding the patient’s care plan and providing less care
• Embezzling, abusing, or neglecting patients
• Medication theft by a hospice worker

How can I stop hospice fraud?

Hospice fraudsters may target residents of assisted living facilities or nursing homes whose life expectancy is longer than six months. Even though they know you’re not qualified, they might use high-pressure and unsolicited sales tactics to encourage you to sign up for hospice services. No matter what the scammer may say, Medicare will not cover or approve life-saving surgery or curative care like cancer treatment for patients who are on hospice.

Fraudsters can make money if they sign you up for hospice care (which typically costs more than routine at-home care) but only provide the at-home care at its normal rate instead of the hospice services they are billing Medicare for.

Some tips for stopping hospice fraud are:

• Make sure your doctor has assessed your health and certified that you are terminally ill (instead of an unsolicited fraudster certifying it!) and that you are expected to live six months or less if the disease or condition runs its normal course.
• Don’t accept gifts such as money, gift cards, or groceries in exchange for hospice services. Remember, if it seems too good to be true, it probably is!
• Report complaints about the quality of care to the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO).
• Check your Medicare Summary Notice (MSN) and Explanation of Benefits (EOB) to make sure you actually received the level of care you were billed for.

What should I do if I am a hospice fraud victim?

If you believe you or someone you know has been a victim of hospice fraud, please do not hesitate to reach out to the Wisconsin SMP. We can send the information on so the appropriate authorities can investigate the situation. You can leave a message on our toll free and confidential helpline at 888-818-2611 or send us an email at smp-wi@gwaar.org.