Dear Viraj, 

As we discussed in our last newsletter, hospice is a program of end-of-life pain management and comfort care for those with a terminal illness. Medicare’s hospice benefit is primarily home-based and covers end-of-life palliative treatment, including support for one’s physical, emotional, and other needs. It is important to remember that the goal of hospice is to help an individual be as comfortable as possible, not to cure an illness. 

Hospice fraud occurs when Medicare is falsely billed for any level of hospice care or service. As the family member of a Medicare beneficiary, you should look out for suspicious behavior from health care providers that might indicate Medicare fraud or abuse.  

Report potential hospice fraud, errors, or abuse if you or a loved one are: 

• Being abused or neglected by a hospice worker 
• Receiving inadequate or incomplete services 
• Not receiving the services and care outlined in your doctor’s plan of care 
• Falsely certified as being terminally ill in order to qualify for the hospice benefit 
• Enrolled in hospice without your or your family’s permission 
• Offered gifts or incentives to receive hospice services or to refer others for hospice services 
• Have your medication stolen by a hospice worker 
• Billed for a higher level of care than was needed or provided, or for services not received (you can find this information on your Medicare Summary Notice or Explanation of Benefits) 
• Experiencing high-pressure and unsolicited marketing tactics of hospice services 
• Kept on hospice care for long periods of time without medical justification 

To report potential hospice care fraud, errors, or abuse, you should contact your local Senior Medicare Patrol (SMP). Your SMP can also help you identify possible concerns. Find your local SMP by visiting www.smpresource.org or calling 877-808-2468. 

-Marci