Good hospice can be immensely valuable. But there are predators.
A wise friend referred me to this New Yorker article last month about a Pro Publica investigation. I skimmed it then, and today I read it in full. It’s appalling. If anyone you know is considering hospice, or has been “invited” by a company to consider it, beware. Here’s what the friend basically said – and they were right:
For-profit hospice is a vast crime scene,
and private equity is holding the knife
Note, I’m talking (and the article talks) about for-profit hospice companies. For-profit hospice chains bill the government four times more per patient than not-for-profits, and focus on both maximizing admissions and cutting costs (i.e. cutting back on services), all the while gaming the system to barely squeak under the wire before Medicare makes them give back the money.
Numerous lawsuits have unearthed company emails and dialogs emphasizing sales “or else” (and actual firings for low sales numbers), and some patients have discovered they’d been enrolled in hospice without their knowledge–which in some cases made them ineligible for the treatment they’d already been getting.
There can be abuses in any for-profit company (or non-profit), but it gets worst when the investors are private equity, which is known for identifying the bare minimum they must do to get paid. Read and you’ll see. (It’s the same as they’ve done to local newspapers (NPR) and this Richmond nursing home (New Yorker).)
If this subject touches your life (which it will, someday) please read the New Yorker article and spread the word: How Hospice Became a For-Profit Hustle.
I have nothing against capitalism per se. But it has to be regulated and enforced, which can be hard, and sometimes they get away with absurd and cruel things and just cashing in. Government enforcers can be outfoxed by high-paid hospice lawyers; as one attorney says in the article, “When a case settles for $1 million where the [questionable insurance filings] have been for over $200 million, I think that speaks for itself.”
Informed consumers (that’s you and me) are our only recourse.
I’m intentionally posting this without telling you all the cruel, cynical things these companies’ employees have done, as described in the article. Please, read it, and spread the word.
And don’t just spread the word in your personal circles: as you’ll see from the very beginning of the article, some of these companies actively seek out vulnerable people to sell to. And they get away with it. (One of them describes wearing scrubs to the door, though she has no medical background, so “I would automatically be seen as a help.”)
Stop them: tell relevant people in your communities to watch out. Good hospice is truly wonderful, but there are predatory companies.
Thank you for this, Dave.
Hi, Erika – anything in particular, or just everything in general?
Never in my wildest dreams did I imagine, when I coined the descriptor Opaque Dying Marketplace that (a) it would apply as completely to hospice as to hospital, and (b) that it would involve such detail, nor sinister aspects. Ay yai yai.
Bart, I hope you have (or had) a chance to read the article. Astoundingly, these predatory business people are looking for people who are NOT dying, and registering THEM into hospice … and then sometimes medicating them into submission so they shut up and stay billable!
Here on your site it’s (relatively) safe to say that I hate the **ckers. (I did read the article).
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Dave, Yikes! This article reveals that any of us could easily have similar experiences, e.g. hit close to home. Thanks for sharing.
So, Bart, the big lesson (I believe) is that when shopping for a hospice provider, pay close attention to whether they’re incorporated for profit. There can be abuse in non-profits, too, but when the whole corporation’s purpose *by law* is to make money for the owners *and regulations are hard to enforce*, the door is wide open for heartless abuse.