Dharamshala fraud.
Why do those two words appear together so often?
The short answer is money. The elderly population is growing, there is a river of tax dollars available to cover the cost of care, and a plethora of scammers and profiteers have lined up banks to sleep with schemes that involve stolen identities and billing for patients who are not actually on their death beds.
Another explanation for the long-running, billion-dollar boondoggle is that despite revelations late in 2020 LA Times investigative reporter Kim Christensen and then-colleague Ben Poston, Reforms promised in California Still, inexplicably, a work in progress.
As my colleagues Richard Winton and Hannah Fry have reported, the Trump administration has singled out California for its failures, while also targeting other states. And meanwhile, Trump’s team and California officials Pointing fingers at each other for not doing their job as both sides are announcing the arrest of several fraudsters.
“California has the clearest current warning sign, but this is not just a California problem. This is a federal Medicare program-integrity problem and a state-federal oversight problem,” Sheila Clark, president and CEO of the California Hospice and Palliative Care Association, testified at a congressional hearing a few days ago.
Body camera footage shows law enforcement working with the California Department of Justice raiding homes in connection with a suspected hospice fraud case.
(California Department of Justice)
Another witness at the same hearing said he was denied Medicare coverage pickleball injury Because she was unknowingly a victim of identity theft and was enrolled in hospice coverage by scammers.
Clark, who was still angry when I spoke to her after her testimony, was one of several people to whom I reached out with a question I’ve received from readers since I wrote several years ago about the problems of hospice care that both my parents dealt with.
When hospice is the best course of care, as it often is, how can consumers avoid scams and make smart choices in deciding among the hundreds of hospice care options?
The first thing you need to know is that hospice is often the right choice and the best option, as hard as it may be to accept this reality. And if you ask your primary care doctor lots of questions, your chances of finding the right fit will be better, Santa Clarita said. Geriatrician Dr. Jean DorioJoe relies on the advice of a hospice and palliative care colleague for recommendations tailored to his patients’ needs.
You should also ask questions to make sure hospice is the right choice, Dorio said. Hospitals, insurance companies and doctors have been known to admit patients to the hospital prematurely for financial reasons, Dorio said. In some cases, patients do not receive the care they need and it costs them their lives.
Putting a twist on that narrative, Dorio said a hospice operator once asked him to examine a patient who came in with a diagnosis of bladder cancer. Dorio said he found no evidence of cancer and the patient was returned for routine care.
Clark noted that Her agency’s website provides several guidelinesWhether your loved one will be in a hospice facility or receive care at home, as most hospice patients do. Clark’s site lists several questions to ask a hospice care provider, such as:
Do they have any connection with your personal physician? What is expected of a family caregiver? Which members of the hospice team will you meet and how often?
Body camera footage shows law enforcement raiding a location ordered by the California Department of Justice in connection with a suspected hospice fraud case.
(California Department of Justice)
There are also links to Clark’s website California Department of Health And Treatment Databases that provide basic information and some comparisons between different hospice companies. You can find details of complaint investigations on the state website and a 1 to 5 star rating, which includes consumer reviews, on the federal site.
But the sites can be difficult to navigate, and as with many companies listed, information is limited, dated or non-existent for a variety of reasons, including exemptions and non-compliance. Smaller companies do not have star ratings.
Sorting through strange government websites in a moment of crisis is no pleasant task, so if you can, it’s best to start exploring options before the deadline arrives.
“Somehow the general public doesn’t understand that there are different hospices,” said Jennifer Moore Ballantine, chief executive of the Coalition for Compassionate Care of California. “Everyone understands the difference between gas stations and grocery stores and phones and football teams, but somehow hospice, in the public mind, is monolithic.”
Several decades ago, hospice was a community-based and faith-based non-profit industry. Compassion was the main currency, with well-meaning efforts to make people as comfortable and pain-free as possible in their final days.
With time the currency itself became the main currency. Hospice had transformed into a massive corporatized, billion-dollar profit-making giant. The biggest regulatory failure was that the startup was not carefully screened before beginning gold digging, and oversight was minimal.
It is as if ageism was a factor in this development. We’re talking about old people, and they’re going to die anyway, so let’s scam Medicare and Medicaid and squeeze out everything we can before grandma and grandpa are gone.
There are good and bad nonprofit organizations and good and bad for-profit organizations, but industry analysts have told me for years that generally speaking, nonprofit organizations are more reliable than for-profits, which can skimp on staffing.
Ballantyne offered several suggestions for choosing a good option.
“My first criteria is: Has the hospice been in existence for more than 15 years?” If so, Ballantine said, “it’s unlikely to be one of the scammers.”
If you know someone who has had a good experience with a hospice company, that’s a good start, Ballentine said. If possible, she adds, “Visit a hospice office, because if it’s a scam, there won’t be an office. Get a feel for the organization. What a great resource this is?”
Susan AnguidanosAssociate Professor of Gerontology at USC, researching and teaching end-of-life care. She has a class in which students are assigned the task of choosing and comparing two hospices.
They use Medicare’s Care-Compare website and find that “it’s very difficult to use … and not all hospices will be listed there,” Enguidanos said.
And then they try Google and Yelp.
“You can learn a lot from observations,” Anguidanos said.
Google and Yelp comments are obviously subjective, no matter what rating is being given. But if you see a 2.5 rating, Enguidanos said, it’s a hospice company you would probably choose.
“The biggest complaint was that the hospice staff didn’t come as expected,” she said of consumer comments on Google and Yelp. “They said they would come,” Anguidanos said, paraphrasing a typical response, “and they never came.”
Grace Lopez, left, with daughter Debbie, before being discharged from the hospital in January 2019.
(Steve Lopez/Los Angeles Times)
This was our experience with my mother in 2020. He was discharged from the hospital and we were told a nurse would be there with his pain medications. The nurse was not there, and we were told there would be a delay because the nurse was taking care of another patient.
My mother endured hours of pain. We fired that hospice agency and hired another who immediately shipped A nurse who had the perfect combination of medical expertise And kind bedroom behavior.
My mother died peacefully and pain-free. And the hospice nurse attended his funeral.
steve.lopez@latimes.com
