Fraud is rampant, but good hospice care exists. Here’s a guide to making the right choice

Hospice Fraud.

Why do those two words always seem to go together?

The short answer is money. The elderly population is growing, a flood of tax dollars is available to cover the costs of care, and fraudsters and profiteers are lining up banks to get their hands on gold through schemes that involve stolen identities and the debts of patients who are not on their deathbeds.

Another explanation for the long-running, multibillion-dollar boondoggle is that despite disclosures like the one in 2020 it’s gone. LA Times investigative reporter Kim Christensen and my colleague Ben Poston, California’s promised reforms it’s still a work in progress, inexplicably.

The Trump administration has singled out California for its failures, as our colleagues Richard Winton and Hannah Fry have reported, while targeting other states as well. And in the meantime, Trump’s team and California officials they point fingers for not doing their job as both sides announce the arrest of many crooks.

“California is a clear sign of the current warning, but this is not just a California problem. It is a federal Medicare-integrity problem and a state-federal oversight problem,” Sheila Clark, president and CEO of the California Hospice and Palliative Care Assn., testified at a congressional hearing a few days ago.

Another witness at the same hearing said he was denied coverage by Medicare because of a pickleball injury because he was an unintended victim of stolen identities and was enlisted by fraudsters in hospice care.

Clark, who was still angry when I spoke to him after his testimony, was one of the few people I reached out to about a question I’ve been getting from readers since writing a few years ago about the hospice issues both of my parents faced.

When hospice is the best course of care, as it often is, how can consumers avoid fraud and make wise decisions in deciding among hundreds of hospice options?

You should know, first of all, that a hospice is often the right choice and the best choice, as it can be as difficult as possible to accept that fact. And your chance of finding the right fit will be better if you ask more questions of your primary care physician, says Santa Clarita. gynecologist Dr. Gene Doriowho relies on advice from the hospice physician and palliative care partner for recommendations that are tailored to the needs of their patients.

You should also ask questions to make sure hospice is the right choice, Dorio says. Hospitals, insurance companies and doctors are known to abandon patients prematurely for financial reasons, Dorio said. In some cases, patients don’t get the care they need and pay with their lives.

Changing that narrative, Dorio said that he was once asked by a hospital worker to examine a patient who came in with bladder cancer. Dorio said he found no evidence of cancer and the patient was returned to routine care.

Clark noted that his agency’s website offers a number of guidelineswhether your loved one will be in a hospice or receive care at home, as most hospital patients do. Clark’s site lists several questions to ask a hospice provider, such as:

Do they have a relationship with your personal doctor? What is expected of a family caregiver? Which members of the hospice will you see and how often?

Body camera footage shows law enforcement and the California Department of Justice raiding the area in connection with an alleged hospice fraud case.

(California Department of Justice)

Clark’s website also has links to California Department of Health again Medicare a website that provides basic information and some comparisons between various hospice companies. You can find information on the investigation of complaints on the state website, and star ratings, from 1 to 5, on the government site, which includes reviews by consumers.

But navigating the sites can be tricky, and because of many listed companies, information is limited, dated or non-existent for a number of reasons, including exemptions and non-compliance. Small companies do not have star ratings.

Sorting through wonky government websites in a time of crisis is no fun task, so it’s best to start exploring options before the end is near, if you can.

“Somehow the general public doesn’t seem to understand that there are different types of hospice,” said Jennifer Moore Ballentine, CEO of the Coalition for Compassionate Care of California. “Everybody understands the difference between gas stations and grocery stores and phones and football teams, but in some ways, hospice, in the public mind, is monolithic.”

A few decades ago, hospice was a community-based and faith-based nonprofit. Compassion was the main currency, and good efforts were made to make people as comfortable and painless as possible in their final days.

Over time, money became the primary currency. Hospice was transformed into a multi-billion dollar behemoth. A major regulatory failure was that the initiative was not thoroughly vetted before gold mining began, and oversight was minimal.

It is as if aging was the cause of this evolution. We’re talking about old people, and they have to die anyway, so let’s attack Medicare and Medicaid and squeeze what we can for our grandparents before they’re gone.

There are good and bad nonprofits and good and bad benefits, but industry analysts have told me for years that, in general, nonprofits are more reliable than for-profits, which can tend to get into the workforce.

Ballentine offered several good selection ideas.

“My first criterion is: Has the hospice been in existence for more than 15 years?” If so, Ballentine said, “it’s impossible to be one of the cheaters.”

If you know someone who has good experience at a hospice company, that’s a good place to start, Ballentine said. If possible, he added, “go and visit the hospice office, because if it’s a fraud, there won’t be an office. Find out about the organization. How much does it know about this organization?”

Susan Enguidanosassociate professor of gerontology at USC, researches and teaches end-of-life care. You have a class where students are assigned to choose two hospice facilities and make a comparison.

They used Medicare’s Care-Compare website and found that it was “very difficult to use … and not all medical facilities will be listed there,” Enguidanos said.

Then they try Google and Yelp.

“You can learn a lot from feedback,” says Enguidanos.

Google and Yelp reviews are obviously not independent, no matter how they are measured. But if you see multiple ratings of 2.5, Enguidanos said, that’s a moribund company you’re unlikely to choose.

“The biggest complaint,” he said of consumer comments on Google and Yelp, was that hospice staff didn’t show up as expected. “They said they would come,” Enguidanos said, giving a typical response, “and they just didn’t show up.”

Grace Lopez, left, with daughter Debbie, before being discharged from hospital to hospice in January 2019.

(Steve Lopez/Los Angeles Times)

That was our experience with my mother in 2020. He was taken from the hospital to the hospital, and we were told that a nurse would be there with his pain medication. The nurse was not there, we were told that it would take some time, because the nurse was taking care of another patient.

My mother endured the pain for hours. We fired that hospice and hired another, which shipped quickly a nurse who had a complete combination of medical skills and a sympathetic bed posture.

My mother died peacefully, without pain. A hospice nurse was also present at his funeral.

steve.lopez@latimes.com