OIG Special Agents Sound Off on Hospice Fraud, CMS Rules


In one example of hospice fraud, a provider was caught billing for 17 days of general inpatient care for a 70-year-old Medicare beneficiary, though a caregiver had never even visited him.

In another case, an owner a hospice was found to be using recruiters to solicit and enroll beneficiaries for hospice care when they were not eligible in the first place.

These are just a few of the many instances of billing fraud happening throughout the hospice industry, collectively costing the government hundreds of millions of dollars each year, according to the U.S. Department of Health and Human Services’ Office of Inspector General (OIG). As the main federal watchdog tasked with sniffing out misconduct related to Medicare, Medicaid and dozens of other government programs, OIG highlighted the cases in a scathing report released last month.

While egregious, they only reveal a fraction of the Medicare hospice program’s numerous overall vulnerabilities, OIG officials and investigators—including a special agent who works undercover—told Home Health Care News during recent follow-up interviews.

“Increasingly, we’re uncovering fraud schemes that are quite concerning,” Jodi Nudelman, regional inspector general for OIG, told HHCN. “Particularly when beneficiaries are just unaware that they’re even being enrolled in hospice.”

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