NCPA - National Center for Policy Analysis

Dying On Schedule Under Medicare

June 5, 2000

Under Medicare rules, people in the final stages of their life can get benefits for six months of care through a hospice. The problem is that people don't always die on schedule. In some cases they live four or even five years longer than predicted by their doctors.

While extensions are sometimes granted, any longer survival can be deemed excessive, can trigger an investigation and cost patients tens of thousands of dollars.

  • The hospice movement began in Britain in the 1960s and grew in the U.S. during the 1990s because -- since most patients are cared for in their homes -- it is less expensive than nursing homes and hospitals.
  • Government reports indicate that Medicare has wrongly paid more than $83 million for hospice care.
  • In late 1997, the Health and Human Services Department warned the Health Care Financing Administration to crack down on hospice benefits -- and letters were then sent to some hospice patients informing them they were being cut off from aid, demanding refunds of benefits already received and ending with an apology "for any inconvenience...."
  • When a hospice in Plattsburg, N.Y., was threatened with bankruptcy due to withholding of payments by Medicare and it decided to fight, an administrative law judge found the hospice had not engaged in fraud simply because some patients lived longer than six months.

But the government says its policies have been effective, and that hospice fraud is on the decline. Between 1994 and 1998, average lengths of stay at hospices dropped about 20 percent to 48 days.

Source: Lucette Lagnado, "Hospice's Patients Beat the Odds, So Medicare Decides to Crackdown," Wall Street Journal, June 5, 2000.


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