Trial Date Set For Passages Hospice Fraud Case

Trial Date Set For Passages Hospice Fraud Case

Posted on Wednesday, October 8th, 2014 at 3:26 pm by lifemediamatters

Passages owner Seth Gillman. (Credit: youtube.com)

Passages owner Seth Gillman via Youtube.com

The health fraud trial date involving Lisle, Illinois-based Passages Hospice has been set for July 6, 2015, an official with the Department of Justice told Life Matters Media.

Seth Gillman, 45, a partial owner who founded the company in 2005, was first charged in January with health care fraud and conspiracy to defraud the government. According to prosecutors, Passages knowingly over-billed the government by millions of dollars for unnecessary hospice care for seniors.

In May, fraud charges were brought against Gwen Hilsabeck, who served as a co-administrator; Carmen Velez, who served as director of clinical services and director of nurses for the Chicago region; and Angela Armenta, who served as director of certified nursing assistants for the Chicago region.

The four defendants, all released on bond, appeared before U.S. Judge Thomas M. Durkin in June and pleaded not guilty. Passages, a corporation, has also pleaded not guilty.

According to prosecutors, Gillman, Hilsabeck, Velez and Armenta participated in an elaborate scheme “to cause Passages Hospice LLC to submit false claims to Medicare and Medicaid for medically unnecessary hospice care, namely, hospice care for patients who were not terminally ill and hospice care that did not qualify for general inpatient care.”

Between August 2008 and January 2012, Medicare paid the for-profit hospice company more than $90 million for hospice services, including more than $20 million for general inpatient services. From 2006 to late 2011, Passages submitted claims for about 4,700 patients to Medicare and Medicaid.

Gillman, Hilsabeck, and Passages allegedly paid bonuses to nursing directors and certified nursing assistant directors employed at the company in order to increase the number of patients receiving general inpatient care. In 2012, Medicare’s daily reimbursement for general inpatient care was $671.84; the daily payment for routine care was much lower, $151.23.

One former employee told LMM she quit after realizing that something felt wrong.

“I left the company a few months before the indictment, after I couldn’t ignore my gut,” she said, asking not to be named as she continues to work in a similar industry. “I was in the dark about the fraud, but I knew deep down I couldn’t be a part of that company anymore. I was appalled to find out how many people were involved in the deceit. I was lucky enough to leave on my own for another job, but my coworkers and friends weren’t. They’re still fighting for pay, vacation time and 401K contributions owed to them.”

In February, Passages closed in light of the allegations. The hospice operated in four states, yet the majority of services were provided to Illinois seniors. Earlier that month, employees told LMM that they vowed to continue operating for patients’ sake.

According to the FBI, federal agents have interviewed patients, family members and more than 30 former and current Passages employees. Several reported the allegedly fraudulent billing and marketing practices to Medicare and law enforcement.

Hospice is generally care provided in a patient’s home, but it can also be provided in a center, hospital, nursing home or other long-term care facility for people facing illness near the end of life. The number of hospice patients served has risen more than 25 percent during the last five years from 1.25 million in 2008, according to figures published by the National Hospice and Palliative Care Organization.

Passages did not operate an inpatient facility, instead deploying nurses to visit hospice patients in nursing homes and private residences. The next status hearing is set for Dec. 8.


Hospice Accountability Legislation Headed To Obama’s Desk

Posted on Monday, September 22nd, 2014 at 7:21 am by lifemediamatters

Medicare Sample Card, Courtesy WikiMedia Commons.

Medicare Sample Card, Courtesy WikiMedia Commons.

Health legislation that supporters say would increase transparency and accountability among hospice providers has been woven into a Medicare bill, passed by both houses of Congress and now headed to President Obama to be signed into law.

In a rare bipartisan display, particularly for health legislation given Affordable Care Act clashes, the U.S. House of Representatives and Senate have passed the “Improving Medicare Post-Acute Care Transformation Act,” or “IMPACT Act,” which includes key elements to bring increased quality, transparency and accountability through more frequent surveys to hospice providers. Obama is expected to sign the legislation.

The hospice industry, which supported the legislation, maintained the language in the IMPACT Act includes “pretty much the same things” that were in the Hospice Act pushed by U.S. Reps. Tom Reed, a New York Republican, and Mike Thompson, a California Democrat. The legislation comes in the wake of mounting criticism that called the safety of hospice patients into question.

“This bill is about strengthening accountability and transparency at hospice facilities so that patients receive the highest quality care possible,” Thompson said in a statement to Life Matters Media. “By putting these accountability measures in place, we can help give patients and their families the peace of mind that they will be able to depend on the care they receive.”

Tomorrow Reed, R-Texas

Rep. Tom Reed

To be sure, the hospice industry has been shaken by government watchdog reports and a recent Washington Post series, “Business of Dying.” Last year, a report by the U.S. Department of Health and Human Services’ Office of Inspector General uncovered evidence that hospice providers would go years without surveys; they are among the few ways watchdogs say patients and families can find an independent record of a facility’s quality.

The language in the IMPACT Act would allow the Centers for Medicare & Medicaid Services (CMS), which holds the purse strings to much of the industry’s funding, to have more clout. All Medicare-certified hospices would be surveyed at least every three years. The three-year cycle is consistent to recommendations in the OIG report.

The hospice industry’s lobby and trade group, National Hospice and Palliative Care Organization (NHPCO), acknowledged the survey problem and maintains that it supports the IMPACT Act, also known as HR 4994. It would dramatically increase the cycle frequency from what has been six to eight years or longer.

Here’s the specific language on the survey:

“Any entity that is certified as a hospice program shall be subject to a standard survey by an appropriate State or local survey agency, or an approved accreditation agency, as determined by the Secretary, not less frequently than once every 36 months beginning 6 months after the date of the enactment of this subparagraph and ending September 30, 2025.”

“Currently, hospices can go eight years or more without ever being surveyed, which is far too long,” Donald Schumacher, NHPCO president and chief executive officer said in a statement.

Hospice is generally considered medical care provided for those facing illness near the end of their lives. It can be provided in a patient’s home, in a center specifically for such patients, or in hospice located in a hospital, nursing home or other long-term care facility. NHPCO figures estimate more than 1.5 million dying Americans receive hospice care each year.

“More consistent surveys, and the process providers go through to prepare for them, will help hospices and ultimately benefit the patients and families in their care,” Schumacher added.

The legislation would also allow CMS staff to “facilitate medical reviews” of patients “receiving care for more than 180 days.” Hospice centers would have to reach a certain threshold, however, before medical reviews would take place.

“The specific patient load that would trigger this medical review is yet to be set by CMS,” according to NHPCO. “Such a medical review of what are known as ‘long stay’ patients will help ensure that hospices are caring for individuals with life-limiting illnesses that are often harder to prognosticate than in the earlier days of hospice care when most patients had a cancer diagnosis.”

Supporters of the legislation say it is the latest push by policymakers to bring more accountability to healthcare. Last year, hospice providers were required to report certain quality measures to the federal government or lose out on a one percent increase in Medicare reimbursement.

The hospice measures are part of IMPACT legislation designed to require “post-acute providers” including long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies to report standardized patient assessment data and quality and “resource use” measures as the Medicare health insurance program for the elderly moves from fee-for-service medicine to more value-based care.

Congressman Reed referenced the bipartisanship in advocating the hospice aspect of the legislation.

“Strengthening hospice care is something people from across the political aisle can come together to support and improve hospice care delivery in America,” Reed said in a statement. “We depend on hospice providers for more than helping our loved once. We also depend on them to bring peace of mind and comfort to our families.”


Reimbursing Doctors For End Of Life Discussions

Posted on Monday, September 8th, 2014 at 8:47 am by lifemediamatters

Medicare could soon begin reimbursing physicians for end of life conversations with patients, almost five years after similar proposals were taken out of the Affordable Care Act.

Bypassing the political process, some private insurers have already started reimbursing doctors for time spent helping patients complete advance health care directives, The New York Times reports. Interest in doctor-patient communication has risen as the millions of baby boomers age.

Sessions for some 50 million other Americans could be covered by Medicare if recent requests from the American Medical Association, the nation’s largest association of physicians and medical students, are approved. The AMA recently created codes for end of life conversations and submitted them to the Centers for Medicare and Medicaid Services (CMS).

“Each year, the AMA provides CMS with revisions to the CPT (Current Procedural Terminology) coding system that is used to price thousands of physician services. In a typical year, there are hundreds of codes that are either new, revised or deleted,” according to a CMS statement sent to Life Matters Media. “Advanced care planning was among the codes sent to us by the AMA.”

CMS may choose to establish payment and cover the sessions as described by the code; not pay for the specific code, but cover the sessions as part of another code; or deny payment. A decision is expected this fall.

“We think it’s really important to incentivize this kind of care,” Dr. Barbara Levy, chair of the AMA committee that sends codes to CMS, told the Times. “The idea is to make sure patients and their families understand the consequences, the pros and cons and options so they can make the best decision for them.”

The signature of President Obama on the Affordable Care Act. Courtesy WikiMedia Commons and whitehouse.gov

The signature of President Obama on the Affordable Care Act. Courtesy WikiMedia Commons and whitehouse.gov

When health care reform was signed into law in 2010, many Democrats wary of being identified with “death panels” dropped all proposals associated with end of life planning, despite support from many medical professionals, caregivers and ethicists.

According to Politifact, a Pulitzer Prize-winning fact checker, comparing end of life counseling to “death panels” was 2009’s “Lie of the Year.” Former vice presidential candidate and Alaska governor Sarah Palin was the first to coin the term “death panels” on her Facebook page after the release of an early draft of the bill. Some conservatives charged that vital care would be cut off to the aged and ill if doctors recommended they receive less aggressive treatments.

Karen N. Long, president of the Chicago End-of-Life Care Coalition, said she believes patients will benefit from one-on-one conversations with doctors about their “goals of care.”

“Everyone in this field has been working on this for a long time. It’s very much needed, because it helps patients think about what’s important to them, what they consider a ‘good’ quality-of-life,” Long told LMM. “I think most of the controversy goes back to the conflated issue of ‘death panels,’ where some individuals misquoted and misunderstood what was in the proposed law.”

An advance health care directive may take the form of a living will, power of attorney or the Five Wishes collection. The overall purpose of such forms is to help ensure that one’s end of life wishes are carried through in case of illness or incapacity.


Hospice Patients More Likely To Be Discharged From For-Profit Programs

Posted on Wednesday, August 13th, 2014 at 8:49 am by lifemediamatters

Courtesy Creative Commons By Denise Mayum

Courtesy Creative Commons By Denise Mayum

Nearly 20 percent of U.S. hospice patients are discharged before death, according to new findings published in the Journal of Palliative Medicine. Not-for-profit and government-owned hospices had lower rates of live discharge than newer for-profit programs.

The researchers, led by Dr. Joan Teno, associate director of the Center for Gerontology and Health Care Research at Brown University Medical School, found that nearly 200,000 of the one million hospice patients discharged in 2010 were still alive (18 percent). Connecticut had the lowest rate of live discharge (13 percent), and Mississippi had the highest (41 percent).

“When you have a live discharge rate that is as high as 30 percent, you have to wonder whether a hospice program is living up to the vision and morality of the founders of hospice,” Teno told The Washington Post. “One part of the reason is some of the new hospice providers may not have the same values — they may be more concerned with profit margins than compassionate care.”

Patients in nonprofit programs were less likely to be discharged while alive than those in similar for-profit programs: 15 percent to 22 percent. More mature programs (those 21 years and older) had lower rates of discharge than those in operation for 5 years or less: 14 percent to 27 percent. “There has been a striking increase in the number of hospice providers with the fastest growth coming from for-profit providers,” authors write.

Hospice care is designed to help comfort the seriously ill near the end of life, and it has become increasingly popular in recent years – reaching nearly $14 billion in payments during 2011. The Medicare hospice benefit, established in 1982 to help patients pay for care, is usually provided only to those with a life expectancy of six months or less. All Medicare hospice discharges between January 1 and December 31, 2010 were analyzed.

The researchers said they are concerned by variation between hospice programs and its effect on patients’ quality-of-life.

“The provider and state variation raises concern that live discharges are not driven by patient preference but by provider and market behavior,” they add. Hospice programs that exceeded their reimbursement caps — a marker for hospices with an excessive average hospice length of stay — had double the rate of live discharges compared to hospice programs that did not exceed their cap.

One in four discharged patients were hospitalized within 30 days, and more than 7 percent were immediately hospitalized and reentered hospice.

Historically, about 15 percent of hospice patients have been discharged for a variety of reasons, including the choice to restart curative treatments. But researchers suggest some newer hospice programs have accepted patients too early and discharging others when costs of their care has risen.

In February, Illinois-based Passages Hospice, LLC was shuttered amidst federal fraud charges. The for-profit hospice, which served hundreds throughout the Midwest, allegedly over-billed Medicare and provided patients unnecessary care.


Medicare Revises Hospice Drug Policy, Local Providers Relieved

Posted on Tuesday, July 22nd, 2014 at 7:39 am by lifemediamatters

Under nationwide pressure from hospices experiencing financial and administrative strain due to a newly implemented policy, the Centers for Medicare and Medicaid Services is revising its own guidance that was intended to help avoid duplicate payments for prescription drugs. This change of course comes two months after the CMS rule’s effective date, months in which providers say the policy jeopardized patient access to end of life care.

SyringeIn May, CMS began to require a prior authorization process for hospices and Medicare Part D providers in order to determine responsibility of drug coverage. Hospices were charged with covering medications not related to the hospice, or terminal, diagnosis. Previously, hospices paid only for drugs needed for symptom management, and Part D policies covered medications for hospice patients’ unrelated conditions.

“Based on discussions with stakeholders, we are adjusting our rules so that beneficiaries enrolled in hospice will continue to have access to their medications while balancing recommendations by the Inspector General meant to safeguard the Medicare program,” said Raymond Thorn of the CMS Office of Communications.

The Office of the Inspector General had recommended the policy’s implementation to minimize mistakes in which Part D plans covered hospice drugs. However, the more than 40 healthcare organizations and hundreds of hospice providers that have lobbied against the rule in recent weeks maintain it unduly burdened beneficiaries, requiring dying patients to navigate payer disputes.

“CMS listened when they convened all the various stakeholders, and heard a unified message focused on protecting beneficiaries from an onerous and insensitive prior authorization process,” said Jonathan Keyserling, Senior Vice President of the National Hospice and Palliative Care Organization. “The announcement of significant modifications in the previous guidance will greatly relieve the stress that patients and families, as well as providers, were experiencing under the prior flawed process.”

Under the revised policy, CMS expects Part D sponsors to use hospice prior authorization only on four drug catagories typically covered under the hospice benefit. They include analgesics, anti-nauseants, laxatives and anti-anxiety medications.

“Barriers to access should be minimized,” Thorn said, as the number of these claims are expected to be minimal.

Providers say the original guidance lengthened admission processes; they maintain it often deterred patients from hospice support if medications taken for decades, psychiatric drugs for example, would not be covered upon enrollment.

“We had changed our admission documentation, and we were starting to have those conversations with new admissions,” said Greg Zrazik, Chief Financial Officer of Angels Grace Hospice in Chicago’s southwest suburbs. “We have been looking at the drugs, trying to determine what we felt we would pay for, what would be paid for by Part D and aggressively looking at things they could consider stoping or could pay for themselves.”

Angels Grace has experienced a 30 percent uptick in drug costs since the rule took effect. Serving 45 patients a day, the hospice experienced a “huge burden” that threatened its financial future; average daily Medicare hospice reimbursement is $160.

“This puts things back to if hospices are doing the right thing, we would certainly recommend a patient come off of drugs that aren’t appropriate,” Zrazik said. “But we don’t have to be aggressive, or make patients make difficult decisions.”

Hospices may realize instant efficiency as a result of this revision, providers say.

“We don’t have to be focused so much on the rigamarole of all the paperwork, and instead we can think more about what the patient and family needs and spend time with them,” said Martha Twaddle, medical director of Journeycare, a hospice serving 500 patients daily across northern Illinois.

Time and personnel are the most important resources a hospice has, said Twaddle, and the extra work the guidance required was threatening the long-term sustainability of quality bedside care.

The tone of the CMS guidance and the agency’s willingness to reverse course are encouraging to end of life care providers.

“If we are going to do good care for Americans, we have to be working together, changing models of delivery and be willing to change ourselves,” Twaddle said. “This is a fabulous sign.”