Lawmakers, Providers Seek Collaboration to Strengthen Hospice Program Integrity

Hospice leaders and lawmakers are meeting on Capitol Hill today to address the pressing issue of program integrity, among other policy priorities.

Driving these conversations are the multiple reports of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona.

Thus far, California is the only state to take action on the issue, beginning with a moratorium on new hospice licenses and an extensive audit of California’s oversight processes.

Meanwhile, calls for a federal response have grown louder.

“The vast majority of people in the industry are committed to the principles and the practice and the delivery. There are, in fact, some outliers. We’ve watched people who’ve just abused the system and compromised the protections and services that have been given to some of our most vulnerable people,” Rep. Earl Blumenauer (D-Ore.) told Hospice News. “There are people who are running hospices programs that are only theoretical. They’re not actually providing services to people, and they are bleeding money from the federal government.”

Arizona had 239 new Medicare-certified hospices appear between 2018 and 2022, representing 52% of all providers in the state. In that time frame, Nevada saw 56 newly certified hospices, and 369 emerged in Texas.

In some instances, multiple hospices have been operating out of the same address without a corresponding increase in the population of eligible patients. Some individuals also hold management positions at several of these hospices simultaneously.

A coalition of industry groups in January called on members of Congress and the U.S. Centers for Medicare & Medicaid Services (CMS) to address this issue, providing 34 recommendations. These organizations included the National Association for Home Care & Hospice (NAHC), National Hospice and Palliative Care Organization (NHPCO), National Partnership for Healthcare and Hospice Innovation (NPHI) and LeadingAge.

Ultimately, developing solutions will require careful collaboration between the hospice community and lawmakers, according NHPCO COO and interim CEO Ben Marcantonio.

“We would be really reinforcing our commitment to working together with congressional leaders and the administration around program integrity and how to really reinforce the quality and the integrity of the programs that are serving people with serious illness and employees,” Marcantonio told Hospice News. “It’s really making sure that other congressional leaders understand the issues and understand what we and others are doing on ensuring that hospice care is delivered in a very responsible and protected way for Americans.”

These conversations took place during NHPCO and Hospice Action Network’s Hospice Action Week, in which leaders from provider organizations met with lawmakers to amplify their public policy priorities.

Most stakeholders said they agree that regulatory action is likely needed to address program integrity, but policymakers must take care to ensure they are taking an effective approach that does not reduce access to care, according to Rep. Beth Van Duyne (R-Texas).

This will require input from the providers themselves, she said.

“We have to be vigilant at getting our information, getting our data and following up. There are opportunities to start making additional regulations. But before we start our policy in place, my first thought right now is talking to more of those people who are providing this critical care, because what I’ve seen so far is that care providers are desperate for regulations,” Van Duyne told Hospice News. “But they don’t want to get lumped in with bad actors, and they don’t want us creating needless regulations that are going to hamper their ability to do that care.”

One factor that hospices have in their favor is that issues on palliative and end-of-life care often garner bipartisan support, even in an often fractious political environment.

“I think this is an area that people will be able to come together and help us refine, in terms of program integrity, what we can do to hold cheaters accountable,” Blumenauer said. “This ought to be something that we ought to be able to come together and do.”

Van Duyne and Blumenauer in February led a group of lawmakers who wrote to CMS Administrator Chiquita Brooks-LaSure, asking for the agency to brief them on fraud and abuse within the hospice benefit.

The issue of fraud has garnered national attention following a recent article from the New Yorker and ProPublica that dug into instances of potential illegal and unethical behavior in the industry. Hospice News published an editorial response to the piece that detailed some of the nuances of eligibility, payment and regulation around end-of-life care.

Among the industry organizations 34 recommendations is a national moratorium on hospice licensing similar to what was done in California.

In that state and at least a handful of others, getting a hospice license has become far too easy, which has created an environment conducive to fraud. This was the conclusion of a 2022 report from the California Department of Justice (CDOJ).

“We’re not doing a good enough job controlling entry into the market, licensing, certification, and we’re not doing enough diligence to make sure that those new actors are performing as they should,” Lynne Sexten, CEO of Wisconsin-based Agrace Hospice & Supportive Care told Hospice News. “Around some of the things that NHPCO and the other trade organizations have put forward around a moratorium — let’s stop all the moving parts and then get our act together.”