Widespread fraud, bribes and other abuses in an industry meant to provide heartwarming care for the dying are at the center of reform proposals that call for a temporary halt to new licenses and a crackdown on recruitment programs. patients in California’s burgeoning palliative care industry.
A bill passing through the state Senate would impose a one-year moratorium on new hospice licenses. A related measure in the assembly would ban hospices from paying recruiters or other “referral sources” for new patients, an area that has been ripe for fraud.
Senator Ben Allen (D-Santa Monica) said his Senate Bill 664 targets “the proliferation of crooks who earn tons of money from both public and private sources” at the expense of vulnerable patients.
The bill, which he said was widely encouraged by a Los Angeles Times investigation released in December, hinges on the state’s auditor accepting his request to examine the sector and report on its findings. conclusions.
“We support and want to see high quality, good quality hospice palliative care in our state and want it to continue to grow,” Allen told the Senate Health Committee this week. “We also want to eliminate the bad actors.”
The Times investigation found that an exponential boom in hospice providers has transformed end-of-life care that was once the domain of charities and religious groups into a multi-billion dollar business dominated by operators. for profit.
Over the past 20 years, the number of U.S. providers has nearly doubled, while Medicare spending on palliative care has increased six-fold, to $ 19.2 billion annually. More than 1.5 million Medicare beneficiaries now receive care from some 5,000 hospices, the vast majority of which are for-profit operators.
Los Angeles County hospices have grown six-fold in the past decade and now represent more than half of the state’s approximately 1,200 Medicare-certified providers, Times analysis of federal care data showed. health.
Dozens of hospices have sprung up along a corridor stretching west from the San Gabriel Valley through the San Fernando Valley, which now has the highest concentration of providers in the country.
The Times found that Glendale had 60 almshouses, while Burbank had 61 and Van Nuys 63. By comparison, New York State and Florida each had less than 50.
Many California hospices are small operations, some purchased as investments by people with little or no healthcare experience. There are few qualifications to start or operate a hospice beyond having a clean crime record, getting a state license, and being Medicare certified, a process that costs just a few. thousands of dollars.
Allen’s bill was approved by the California Advocates for Nursing Home Reform, which cited the Times report in a letter to lawmakers saying “It’s time to hit the pause button on expansion of care. palliatives ”in California.
“The SB 664 moratorium will prevent more bad actors from entering the palliative care sector while giving the state time to create a system that selects operators to ensure they are qualified and their services are needed, ”wrote Executive Director Patricia McGinnis.
“Dying Californians deserve much better than being exploited by corrupt hospice providers,” she said.
So far, the bill has encountered no formal opposition. Peter Kellison, speaking on behalf of the California Hospice and Palliative Care Assn., Told Allen’s committee that his organization was concerned about the effectiveness of a moratorium, but was neutral on the legislation.
“There is no doubt,” he said, there has been “appalling public abuse by these unscrupulous hospice providers who have been highlighted in media reports. , coverage and government reports. ”
A second draft law in the works responds to another of the Times’ main findings, namely that the cutthroat competition for new patients has spawned a cottage industry of bribes for doctors and crooked recruiters who focus on patients. potential patients in nursing homes and other places.
To qualify for palliative care, patients must be certified as terminally ill by their treating physicians, if they have any, and by a palliative care physician.
But many of those signed up by recruiters with promises of medical care, equipment or housekeeping services did not die, the Times found. Some later learned that they had given up their rights to life-saving emergency medical care.
Sponsored by MP Jacqui Irwin (D-Thousand Oaks), Assembly Bill 1280 would prohibit hospice providers or their agents from paying recruiters or others for patient referrals. It also prohibits hospice workers, salespeople, or anyone else who receives any form of remuneration for referrals from providing advice on eligibility or services.
“Tackling the sick and dying is despicable and it is unacceptable that California is leading the country in palliative care fraud,” said Irwin, calling his bill a “first step” in tackling the hospice. financial incentives that can lead to fraud.
“We need checks and balances to help people and gatekeepers, who are often under duress, to make these difficult decisions,” she said. “We have a responsibility to ensure that patients at the end of their life receive the right care that meets the needs of patients and their families.”