Fraudulent activity in the hospice space may be leaving some families without sufficient bereavement support.
Fraudulent hospice schemes can take a tremendous toll on families that have lost loved ones who received poor or negligent end-of-life care, according to Cheryl Kraus, director of government affairs and policy at the Hospice & Palliative Care Association of New York State (HPCANYS).
Victimized families are at greater risk of having complicated grief experiences, Kraus stated.
“The impacts of fraudulent activity in hospice on patients and their families can be devastating,” Kraus told Hospice News. “Substandard hospice care can have a profound impact on bereavement experiences by causing additional distress, guilt and regret for families who may question whether their loved one’s suffering could have been alleviated with proper care. The lack of pain management [and] emotional support and the overall neglect can prolong the grieving process, hindering the family’s ability to find peace and acceptance after their loss.”
Fraud can contribute to complicated grief
Program integrity issues have heated up in the hospice industry, particularly in four hotbed states of Arizona, California, Nevada and Texas.
The grief journey is already a challenging feat for many families without the issue being compounded by the confusion, anger and mistrust associated with fraudulent experiences, Kraus indicated.
Families of victimized patients often experience feelings of betrayal and mistrust, unresolved anger and guilt, lack of closure due to questionable care provided to their loved one, which can result in complicated grief outcomes, according to Kraus.
Additional factors in these families’ difficult bereavement experiences include financial strain from potential fraudulent billing practices alongside confusion and uncertainty about the circumstances surrounding their loved one’s death, she added.
“It’s tragic if you’re already grieving the loss of a loved one to have your suspicions confirmed that they did not receive the level of care that they were entitled to because of bad actors in the hospice space,” Kraus said. “It just shocks the conscience what these fraudulent hospices are doing to people. It’s going to take a long time to restore not just the individuals’ trust who have experienced this firsthand, but also the public’s.”
The impacts of fraudulent activity in hospice on patients and their families can be devastating. It’s going to take a long time to restore not just the individuals’ trust who have experienced this firsthand, but also the public’s.
— Cheryl Kraus, director of government affairs and policy, Hospice & Palliative Care Association of New York State
The U.S. Centers for Medicare & Medicaid Services (CMS) requires hospices to offer bereavement care for a minimum of 13 months following a patient’s death. Many providers extend those services to their entire communities, regardless of whether the deceased was a patient.
Bad actors in the hospice space often do not provide sufficient bereavement support, which negatively impacts quality outcomes, according to Sheila Clark, president of the California Hospice and Palliative Care Association (CHAPCA).
Family caregivers are among those with some of the greatest unmet bereavement needs, according to a study published in the Journal of Social Work in End-of-Life & Palliative Care. Caregivers in the study reported a lack of communication from hospice providers about the grieving process and supportive resources as a leading cause for lower satisfaction and poor quality outcomes.
“It’s that guilt and shame that they are going to take with them in the turmoil if they’re not provided good care,” Clark told Hospice News. “That person watching their loved one without pain being managed is grieving, and that’s awful to try to advocate for them. They’re going to carry that.”
Erosive future impacts
Individuals experiencing complicated grief are often consumed by persistent thoughts around the details surrounding their loved ones’ death, according to Kraus. They may avoid reminders of the loss, struggle to understand the circumstances and have tremendous difficulty navigating a complex range of emotions, she added.
Listening sessions with families of hospice descendents across California has led to a greater understanding of the grief impacts of program integrity issues in the state, Clark said. Lagging bereavement support combined with poor or negligent hospice experiences can lead to lasting emotional and psychological impacts for victims of fraud, she stated.
“When it comes to program integrity, what we learned in those listening sessions is that their families feel like they were hoodwinked, that they were taken advantage of,” Clark said. “It’s calming all these fears in a family just trying to get to the bottom of what happened [and] whether it was a fraudulent hospice election. Was informed consent given? Was their loved one appropriate for hospice? It’s untangling all of that.”
When it comes to program integrity … [these] families feel like they were hoodwinked, that they were taken advantage of. It’s that guilt and shame that they are going to take with them in the turmoil if they’re not provided good care.
— Sheila Clark, president, California Hospice and Palliative Care Association
The public’s trust and understanding of hospice care is being eroded by fraudulent activity in the space, according to Kraus. The lasting effects include greater barriers of hospice awareness, access and utilization that could amplify health disparities and poor bereavement outcomes among underserved populations, she added.
“There are already concerns and misconceptions about what hospice is, and this is going to drive a wedge further and create another barrier to receiving quality care,” Kraus told Hospice News. “With the health equity issues, these bad actors in hospice are having long-term effects – it’s a particularly egregious form of health care fraud. Being a victim of that fraud is another impediment or barrier to them wanting hospice care and their decision-making at the end of life. It’s another layer of tragedy to all of this.”
Companies featured in this article:
California Hospice and Palliative Care Association, Hospice & Palliative Care Association of New York State