Texas Lawmakers Address Rampant Hospice Fraud

Texas has become a hotspot for hospice care fraud, according to a leading provider. Testimonies suggest that some operators are illegally billing Medicare for millions, with patients enrolled in hospice services without their knowledge. In fact, one provider reportedly managed to run up to 15 hospices from a single location.

Lisa McNair, who is the president and CEO of Hospice Brazos Valley, presented this information to the Texas Senate Health and Human Services Committee. She noted that the number of licensed hospices in Texas has nearly doubled over the past six years, now exceeding 1,300 facilities that aim to support patients in their final days. McNair shared with local media that this fraudulent billing could significantly undermine trust in legitimate end-of-life care.

I mean, just think about it: one individual allegedly claimed to operate multiple hospices all in one building, with each facility able to pull in around $60,000 monthly in Medicare claims based on just 10 patients. That’s a serious red flag.

She pointed out that some individuals who are marked as “patients” may not even realize they’re enrolled in these services. The hospice in question simply bills in their names without their knowledge.

Interestingly, McNair also observed that some hospices report a 100% survival rate to discharge from hospitals, which raises eyebrows. “People typically don’t enter hospice expecting to leave alive,” she argued. If every person registered for hospice care ends up being discharged, it raises concerns about the legitimacy of those claims. Why? Because, in her opinion, these individuals were never truly in need of hospice services.

In light of recent fraud scandals in states like Minnesota and California, Texas Governor Greg Abbott has taken steps to combat these issues, emphasizing that misuse of taxpayer money will not be tolerated. While his earlier efforts focused on child care fraud, a broader discussion on Medicare fraud took place in a recent legislative hearing.

Dr. Hemet Oz, a CMS Administrator, indicated that there will be a growing federal focus on hospice agencies in Texas. He noted that some fraudsters are relocating from California to Texas, which complicates the landscape further.

Notably, last year, the Justice Department’s Office of Inspector General charged seven individuals in Houston with orchestrating a $110 million hospice fraud scheme. According to the indictment, these individuals fraudulently billed Medicare and Medicaid for hospice care that was never genuinely provided.

As investigations ramp up, Texas lawmakers face the mounting challenge of closing loopholes that have allowed this fraudulent activity to flourish. With so much taxpayer money on the line, and vulnerable families affected, the question remains: will Texas finally rein in these practices and restore trust in legitimate hospice care?