We’re hearing a lot about fraud in federal programs lately.
The new Ground Zero for fraud is in California, where a perfect storm of bad government has formed in the last few years. The worst cases involve Medicare and Medicaid.
Hospice care has become a source of large-scale billing fraud. There are about 1,800 licensed hospices providing end-of-life care in Los Angeles County, more than six times the national average given its senior population. An eye-popping 89 companies are registered to a single building in Van Nuys.
Many of the others are likely “ghost hospices,” run by thieves who stole medical personnel’s identities to obtain licenses. Patients who did not need end-of-life care were then either fraudulently placed on it or enticed into it. That resulted int them being frequently cut off from the treatments they did need.
I’ve felt personal pain and anger over these types of scandals. A few years ago, my 87-year-old father in Sacramento mistakenly and prematurely went into hospice which meant Medicare payments for his ailments were foregone. Because the hospice was getting a per-diem payment for his care, other providers delayed or denied him physical therapy for a hip injury and access to his regular doctors. It took my family months to sort things out before my father died.
Legitimate hospice remains important for people who actually need it. The fraud problem puts that care at risk.
Waste or fraud has no place in a system that is intended to protect the elderly, society’s most vulnerable citizens. I’m glad that bad actors are being prosecuted, emergency rules are being used to better vet providers and Dr. Mehmet Oz, the head of the Centers for Medicare & Medicaid Services for the federal government, has made better delivery of care a priority and is closing the loopholes in the programs.
At the same time, we shouldn’t confuse fraud or sloppiness committed by bad actors with the care itself. In May, Dr. Oz announced a six-month national moratorium on hospice and home health enrollment in response to abuses in high-fraud markets like Los Angeles.
The goal is laudable, to improve the integrity of these valuable programs. But are we negatively impacting some seniors as we throw out the fraud bathwater?
A one-size-fits-all enrollment moratorium may not make sense where patient demand is growing. That could lead to longer wait times, reduced service availability, and fewer choices for patients – particularly in rural or underserved communities.
A better approach would be a targeted strategy that makes distinctions between fraud trouble spots and communities where such abuses are not an identified problem and patients already face shortages of providers.
My family faced a difficult conversation when my father fell out of his bed and was in chronic pain. He needed help with bathing and getting dressed.
We didn’t want the answer to be institutional care, either in hospitals or nursing homes with sky-high costs. Instead, we opted for home-based health care in a setting he already felt comfortable in.
What made sense for our family can also benefit taxpayers. Expanded use of home health care services could save Medicare billions of dollars per year. If new rules better screening patients for hospice care are enforced, a study by MIT suggests proper hospice care can generate $29,000 in savings for Medicare per patient.
Home-based care allows patients to stay healthier in a familiar environment, and reduces unnecessary emergency room visits, hospitalizations, and high-cost interventions. All that helps improve health outcomes and reduces costs.
The current fraud investigations should remind us that better oversight and enforcement of Medicare and Medicaid is critical. What these incidents shouldn’t do is cause us to lose confidence in care that’s helping millions of Americans every day. The bad actors and fraudsters deserve the attention they’re getting in California and around the nation.
Home-based care deserves better. So do the seniors and families that rely on it.
John Fund is a nationally recognized columnist and author, currently serving as National Review’s national-affairs reporter.