Community Healthcare of Texas CEO Viki Jingle has kept her finger on the pulse of potential hospice fraud occurring in her home state.

She and her colleagues recently brought a range of concerns to a discussion with Rep. Beth Van Duyne (R-Texas) in Community Healthcare’s second meeting with the Congress member. Van Duyne has been among the legislators who have been most vocal about hospice fraud since the problem began to emerge.

Among the most important issues under discussion is a rash of newly licensed hospice operators in multiple states that some have associated with suspicious or unethical practices. The issue first gained attention in 2022 in California, but stakeholders have also raised concerns about providers in Nevada, Arizona and Texas.

Hospice News sat down with Jingle to talk about how these concerns are presenting themselves in her markets, how regulators should respond and the benefits of engaging with policymakers.

What are you seeing happening in Texas in regard to fraud?

I’ve talked to a number of my counterparts in California, Nevada and Arizona, and we’re not seeing it to the extent that they have, thank goodness. However, it is creeping into our state.

What we’re seeing more than anything is just the large number of hospices that are starting up. Just since 2020, 30% of the hospices in Texas are brand new, established just in the last three years. So there is definitely an influx of hospices here in Texas, more than we’ve ever seen before.

There’s 800 hospices in Texas right now, and more than 300 of them are under 20 patients. So we’re seeing this huge influx of new hospices, all for-profit, that are coming into our state, and a large majority of them are staying under the radar at 30 or below in their average daily census. 

We are seeing one owner for multiple hospices, which, again, is concerning when we’re seeing this large influx. They have multiple hospices. They have a large cap liability, and they have a very large live discharge rate.

All of those combined just speak volumes about this. We shouldn’t see this large cap liability. We should not see a large amount of live discharges in Texas. This is what we found when we were doing some research getting ready for our meeting with Rep. Van Dyne.

Has the state done anything to respond to these issues?

We have been trying to get in at the state level, but our state legislature only meets every other year, so it’s difficult to get their attention when they are in session. So the answer is no.

Can you talk about some of the issues you discussed with Rep. Van Duyne in your meeting?

The largest concern that we were there to ask her [about] is the initiation of a moratorium on new hospices coming into our state. I would really like to see a national moratorium, but I’m focusing just on Texas. The reason for that is, we have 800 hospices here in Texas. We have a 54% saturation level of Medicare beneficiaries on the death ratio. 

We’re saturated in what we think are appropriate hospice patients. So there is no need for new hospices in our state, and so I’d really like to see a moratorium.

Our other ask was to really work with [the U.S. Centers for Medicare & Medicaid Services (CMS)] on what they’re actually auditing for. As we talk about these live discharge rates, for instance, why isn’t CMS targeting those? Why are they not targeting these hospices that have large live discharge rates and large cap rates?

Those seem to be the two areas that really should be under their focus. Instead, what they’re focusing on are [General Inpatient Care utilization] rates. That’s not necessarily an egregious thing that’s happening in our state. We only have a 0.6% GIP rate in the state of Texas.

You mentioned the moratorium, but what other kinds of actions would you like to see at the federal level to address these problems?

I really think they should focus on some of the high areas of abuse, high live discharge rates, high cap rates. They really need to drill into ownership. Nothing was really done about the places that had multiple hospices in one physical address and or multiple hospices owned by one provider in a small geographic area. So that’s really on my mind.

Who’s taking the cancer patients? Who’s taking these high-acuity patients? Have them drill into that. Who is actually meeting the needs of our communities with what hospice was truly designed for?