Poor, uncoordinated hospice oversight by government agencies in California has contributed to widespread fraud and other violations, according to a report from the state’s Department of Justice (CDOJ).
The report follows an audit of California’s agencies that oversee hospice providers, including the licensure process. The state’s legislature last October approved two bills requiring this audit and instituting a moratorium on new provider licenses.
“The state’s weak controls have created the opportunity for large-scale fraud and abuse,” CDOJ indicated in its report. “We identified numerous indicators of such fraud and abuse by hospice agencies, which typically offer palliative end-of-life care to individuals with medical diagnoses of fewer than six months to live.”
The department cited contributing factors such as a rapid rise in the number of hospices in the state with no clear correlation to community needs, as well as excessive geographic clustering of separate providers. Auditors also raised concerns about duration of lengths of stay, live discharges and identity theft among hospice staff.
California for more than a year has been cracking down on hospice fraud and other regulatory violations. Stakeholders in the state’s hospice community have voiced support for these efforts to root out bad actors.
“We applaud the continued excellent investigative reporting on this important issue,” Mike Milward, CEO of California Hospice Network, told Hospice News. “Californians deserve the highest quality end-of-life care, and they need to know that they have clear and important choices about who provides that care.”
The state sharpened its gaze on the hospice space in the wake of two 2019 OIG reports showing that about 20% of hospices surveyed by regulators or accreditors between 2012 and 2016 had a condition-level deficiency that posed a serious patient safety risk.
California and Texas were the states that saw the most serious deficiencies, according to OIG.
Earlier this month state legislators proposed a bill that, if enacted, would require signatures from two physicians to recertify a patient for hospice.
CDOJ recommended that the four oversight agencies convene a taskforce to identify, investigate, and prosecute fraud and abuse by hospice agencies in that county, as well as annually meet to conduct a risk assessment of the Medi-Cal hospice program statewide.
DOJ also indicated that it would provide more detailed guidance to the state’s Department of Public Health when it refers fraud complaints for litigation or prosecution.
CDOJ said similar findings occurred among home health agencies and suggested that corrective actions should include those providers.
“The report highlighted how the rapid growth of hospices — almost all of which are for-profit — has put patients at risk of substandard care at a time when they are at their most vulnerable,” Craig Dresang, CEO of California-based YoloCares, told Hospice News. “We support the State of California’s work to protect both the integrity of hospice care and the consumers who need it.”
Companies featured in this article:
