Hospices have suffered more bad press due to the actions of fraudulent actors in the space.

The HBO satirical news program Last Week Tonight with John Oliver on August 19 aired a segment on hospice fraud, waste and abuse. Early in the program, Oliver, who hosts the show, acknowledged the value of hospice care done right.

“Lots of dedicated people work with hospices, providing huge relief for dying patients and their families, particularly those who want to remain at home, where, in most cases, hospice care is provided,” Oliver said on the air. “About 1.8 million Medicare beneficiaries now receive hospice care each year. In fact, you’ll probably encounter hospice at some point in your life, either for yourself or for a loved one. And, at its best, it is great.”

But in between the jokes and parodized hospice ads, Oliver cited example after example of the malfeasance that plagues some of the industry. The broadcast cited a series of government reports and the well-known ProPublica/New Yorker investigation that referred to hospice care as a “for-profit hustle.”

Hospice News can speak with experience that covering the issue of hospice fraud is difficult and complex. Stakeholders, including patients and families, do need to know about the potential risks that bad actors pose, as do regulators and providers themselves. Fraudulent hospices must be exposed, and they must be held accountable. This battle cannot be fought in the dark.

On the other side of the coin, one runs the risk of painting all hospices with a broad brush and tarnishing the reputations of bonafide providers that consistently act with integrity with the best interests of their patients in mind. Stories like these can foster fear among families and dissuade them from pursuing essential, compassionate end-of-life care.

Compounding this is the reality that journalists and broadcasters have limited time and space to cover the full range of nuances that affect this issue. Audiences need a substantial amount of context to fully understand both these problems and the nature of hospice care in general. This is often more than can be addressed in a 30-minute television bit or a single news article. For example, one could write thousands of words on the issue of live discharges alone, which came up briefly during the HBO show.

Last Week Tonight researched the story for more than a year, and the airing was delayed due to the 2023 Hollywood writers’ strike. In the course of this, producers from the show contacted Hospice News.

In a series of phone calls and emails, we strove to give an accurate accounting of the problems we and others have observed, as well as highlighting the efforts that hospices have made to combat them. We also pointed to real-life examples of the way hospices go above and beyond to ensure that their patients have the best possible quality of life. Little of that information appeared in the segment.

Moreover, many of the cases and investigations cited in the program were dated. It included virtually no discussion of the actions hospices, congressional leaders and regulatory agencies have taken to fight back against fraud during the past two years, though it did touch on some state actions like California’s licensing moratorium.

No one has been more outraged or outspoken about these types of fraud than hospice providers themselves.

Like many of these stories, the John Oliver segment did not mention that many of these problems exist throughout the health care industry. Instances of fraud exist in every corner of the care continuum, and hospices should not be singled out.

The show also did not specify that a plurality of these incidents have occurred among new providers that cropped up predominantly in four states — California, Nevada, Texas and Arizona.

The newly combined National Association for Home Care & Hospice and National Hospice and Palliative Care Organization (NAHC-NHPCO Alliance) issued a statement in response to the Last Week Tonight story raising some of those concerns.

“Unfortunately, just as fraud exists in all segments of our health care system, there is fraud that targets the Medicare hospice benefit and harms patients. The issue has received more attention in recent years based both on media coverage and on the advocacy efforts of the hospice community, which universally wants to see the end to fraud,” the alliance indicated in a statement. “For five years, we have been working closely with the Centers for Medicare & Medicaid Services (CMS) and Congress to develop and effectively implement regulations that root out fraud, protect patients and ensure the ongoing value and viability of the Medicare hospice benefit.”

For those of us who care deeply about hospice, our first impulse may be to get angry and defensive, and perhaps blame the messenger. But, ultimately, the most frustrating thing about covering stories like these is that many of them are real. And while the priority must always be the devastating impact that hospice fraud has on patients and families, one must acknowledge the significant damage that fraudulent actors also have on the provider community.

The public needs to know what is happening in their health care system and how it could affect them. They also need to know about the good hospices can do for their loved ones and be given the tools and resources to identify quality providers and make an informed decision.

To counter the impact of fraudulent companies, the hospice community must continue dialogue with state and federal governments on how these problems should be addressed without inadvertently penalizing hospices that have done nothing wrong.

Honest hospices will also have to amplify their message to patients and families, including the stories of how they’ve benefitted patients and families and their own advocacy to combat the serpents in their garden. None of this work will be easy, but it is imperative.