| Dear Marci, Someone at my senior center told me that I should be on the lookout for hospice care fraud. What is hospice care fraud, and how can I protect myself? -Sabrina (Sacramento, CA) Dear Sabrina, Medicare fraud and abuse involve a wide range of behaviors that result in unnecessary costs to the Medicare program, costs for the beneficiary, or other harm to the beneficiary. Medicare fraud may take place on a small scale, like through the actions of one health care provider, or on a much larger scale. Hospice is a primarily home-based program of pain management and comfort care for those with a terminal illness. Hospice care has been identified as one area of Medicare that is vulnerable to fraud and abuse. For this reason, it is important to know what hospice care fraud might look like, so you can identify and report it. Some examples of hospice care fraud include:Providing services to patients who are not terminally illPaying incentives to referral services (such as physicians or nursing homes)Billing for a higher level of care than was actually provided or neededTargeting assisted living facility and nursing home residents whose life expectancy exceeds six monthsFailing to obtain physician certification on plans of careFalsifying records to fake eligibility or physician certificationHigh-pressure marketing of hospice services to beneficiaries who do not qualify for Medicare-covered hospice careProviding inadequate or incomplete servicesTo protect yourself from hospice care fraud, remember the rules around Medicare’s coverage of hospice care services. Medicare will not cover these services for someone who is not terminally ill, and who has not signed a statement electing to have Medicare pay for palliative care rather than curative care, except for in very limited circumstances where a hospice provider is participating in a demonstration program called the Medicare Care Choices Model (MCCP). If you do not meet both of those requirements, and the hospice is not in MCCP, providers should not provide you with, or offer to provide you with hospice services. Protect your Medicare number. Only give your Medicare number or Social Security number to your doctors and other providers. Be careful when others ask for your Medicare number or offer free services if you provide your Medicare number. Check your Medicare Summary Notices (MSNs)and billing statements regularly. Carefully look for any suspicious charges or errors. Use a calendar to track your doctors’ appointments and services to be able to quickly spot fraud or billing mistakes. Remember also that providers are not permitted to routinely waive cost-sharing for Medicare beneficiaries or offer gifts or financial incentives for you to get services from them. Keep your eye out for offers to provide services that are never covered by Medicare. If you see any suspicious charges on your MSN, or have any reason to believe your provider is inappropriately billing Medicare for hospice care, call your provider or billing office to see if they have made a billing error. If you still suspect a provider of hospice care fraud, contact your Senior Medicare Patrol (SMP).Your SMP can provide you with information to protect yourself from Medicare fraud, errors, and abuse. Additionally, if you have quality of care complaints about your hospice provider, your SMP can help you contact the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) for your region. -Marci |