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

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.


Passages Hospice Founder Pleads Not Guilty

Posted on Sunday, June 8th, 2014 at 3:37 pm by lifemediamatters

U.S. District Court of the Northern District of Illinois. Google Maps.

U.S. District Court of the Northern District of Illinois. Google Maps.

Four former high-level employees of shuttered Passages Hospice LLC entered a plea of not guilty to health fraud during an arraignment Monday in the U.S. District Court of the Northern District.

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 on 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 the 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 defendants, each released on bond, appeared before U.S. Judge Thomas M. Durkin. A trial date has been set for August 7; Passages Hospice, a corporation, will likely enter a plea then.

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.

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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 against Gillman. 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.


More Charged In Passages Hospice Fraud Scandal

Posted on Monday, May 26th, 2014 at 2:17 pm by lifemediamatters

More high-level employees of shuttered Passages Hospice LLC have been charged with health care fraud, according to an indictment released by the U.S. Attorney’s office.

Fraud charges have been brought against Gwen Hilsabeck, who served as a co-administrator; Carmen Velez, who served as the 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, according to an indictment filed in the U.S. District Court of the Northern District.

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

According to the indictment, 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.”

Seth Gillman

Passages Hospice Founder Seth Gillman. Honorable Mention in the 2013 Torch Awards for Marketplace Ethics, hosted by the Better Business Bureau. YouTube.

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.

“Give patients everything they need, even that little extra that makes life worth living,” Gillman told Life Matters Media in November during the unveiling of an end of life care initiative backed by the National Institute for Nursing Research.

However, federal prosecutors allege Gillman was not so selfless.

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.

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.

In February, Passages closed in light of the allegations against Gillman. 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.

All four individual defendants, and Passages, are scheduled to be arraigned June 2 in U.S. District Court. The defendants were charged in an 18-count indictment.

Each count of health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine. Conspiracy to obstruct a federal audit and making false statements regarding a health care benefit program each carry a maximum sentence of five years in prison and a $250,000 fine. Restitution is mandatory.

Gillman, an attorney who told LMM he founded Passages after witnessing his grandmother’s poor end of life care in a south Florida hospice, was the corporate agent, administrator and one-fourth owner of Lisle-based company. Passages did not operate its own inpatient facility, instead deploying nurses to visit hospice patients in nursing homes and private residences.

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 Hospice Responds To Health Fraud Charges Against Founder

Posted on Thursday, February 6th, 2014 at 8:18 am by lifemediamatters

As Passages Hospice founder and owner Seth Gillman faces federal fraud charges, employees of the for-profit Illinois health care company are vowing to continue providing care to their terminally ill patients.

Gillman has been charged with both health care fraud and obstructing a federal audit. According to prosecutors, Gillman knowingly over-billed the government for hospice care provided to seniors across the state.

According to the charges, Gillman engaged in an elaborate scheme to obtain higher Medicare and Medicaid payments by fraudulently elevating the level of hospice care for patients, many of whom resided in nursing homes he controlled. Some patients were not terminally ill, and they wound up enrolled in hospice care far longer than the required estimated life expectancy of six months or less.

Kansas Swain, Passages public relations director, said Gillman has “stepped away” from the company.

“Mr. Gillman will have to answer for the allegations that have been placed against him, but Passages has been cleared,” Swain said.

Gillman also allegedly trained nurses to look for signs that would qualify a hospice patient for general inpatient care (GIP). For fiscal year 2012, Medicare’s daily reimbursement for GIP was $671.84; the daily payment for routine care was much lower, at $151.23.

From 2006 to late 2011, Passages submitted claims for about 4,700 patients to Medicare and Medicaid. The company received payments of  approximately $95 million from Medicare and approximately $30 million from Medicaid.

Gillman, freed on $150,000 bond, faces 15 years in prison and $500,000 in fines. From March 2009 through April 2011, he allegedly authorized nearly $850,000 in bonuses for himself.

Swain, who described Gillman as a “hard-working” man with an “innovative vision,” said it was difficult for the hospice staff to learn of the allegations.

“The most important thing to him was the patients,” Swain said. “We want to move forward and restore public trust. Nothing has been interrupted.”

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

Passages Hospice Founder Faces Federal Health Fraud Charge

Passages Founder Faces Federal Health Fraud Charge

The allegations have created a chilling effect on other Illinois hospices.

Jeff Okazaki, communications director for Rainbow Hospice and Palliative Care, a non-profit, said he was not surprised by the allegations.

“Unfortunately, it is something that we’ve seen in the industry across the board now with a lot of the big, for-profit hospices facing lawsuits with these sorts of charges,” Okazaki said.

Rainbow Hospice advises that patients and families look for accreditation before enrolling, specifically from the Community Health Accreditation Program (CHAP). “Anybody can deliver quality hospice care, but it really comes down to the priorities,” Okazaki added.

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

Okazaki said patients enrolled in hospice should be reviewed about every 90 days by a physician or nurse practitioner to ensure that they are terminal and thus eligible for hospice benefits. Medicare may request documentation about patients enrolled in hospice.

Mary Runge, president of non-profit Horizon Hospice & Palliative Care, said that her biggest concern in the wake of these charges is public perception.

“When something like this happens, it hurts everybody,” Runge said. “I realize these are allegations, but this is not the way the majority of hospices operate. We follow the Medicare rules and regulations.”

She said the alleged conduct at Passages is not reflective of any practice in the industry. “There are so many wonderful hospices in the area,” Runge said. “Whether you are for-profit or not-for-profit, you have to follow the guidelines- and go beyond them, frankly.”

Dr. Balu Natarajan, chief medical officer with Seasons Healthcare Management Inc., said Medicare guidelines require its interdisciplinary team to meet every two weeks to determine an individualized care plan for every patient enrolled in the for-profit hospice program.

“At Seasons, we follow the Medicare guidelines when determining if a person qualifies for the Medicare hospice benefit,” Natarajan said. “The basic principle: two physicians must certify terminal illness, specifically noting that life expectancy is less than six months. Certain diseases have more specific admission and recertification guidelines, according to Medicare. We follow those admission and recertification guidelines diligently.”


Passages Hospice Founder Faces Health Fraud Charges

Posted on Wednesday, January 29th, 2014 at 5:51 am by lifemediamatters

Seth Gillman, founder and partial owner of Passages Hospice LLC, has been charged with health care fraud. According to prosecutors, Gillman knowingly over-billed the government for hospice care for Illinois seniors.

“Give patients everything they need, even that little extra that makes life worth living,” Gillman told Life Matters Media in November during the unveiling of an end of life care initiative backed by the National Institute for Nursing Research. But according to the fraud charges released Monday, federal prosecutors allege Gillman was not so selfless.

According to the charges, Gillman engaged in an elaborate scheme to obtain higher Medicare and Medicaid payments by fraudulently elevating the level of hospice care for patients, many of whom resided at nursing homes he also controlled across the state. Some patients were not terminally ill, and they wound up enrolled in hospice care far longer than the required life expectancy of six months or less.

Gillman also allegedly trained nurses to look for signs that would qualify a hospice patient for general inpatient care (GIP). For fiscal year 2012, Medicare’s daily reimbursement for GIP was $671.84, while the daily payment for routine care was much lower at $151.23.

From 2006 to late 2011, Passages submitted claims for about 4,700 patients to Medicare and Medicaid and was paid approximately $95 million from Medicare and approximately $30 million from Medicaid. Between July 2008 and late 2011, Passages was paid $23 million by Medicare for GIP services, in addition to Medicaid payments for similar services submitted on behalf of about 200 patients.

Gillman, 46, of Lincolnwood, IL was charged with one count each of health care fraud and obstructing a federal audit in a criminal complaint that was filed in U.S. District Court late last week.

Gillman, an attorney who founded Passages after witnessing his grandmother’s poor end of life care in a hospice in south Florida, is the corporate agent, administrator and one-fourth owner of Lisle-based Passages Hospice LLC. He is the agent and secretary of Asta Healthcare Company Inc., which operates a handful of Asta Care Center nursing homes across the state– Passages did not have its own inpatient facility but instead deployed nurses to visit hospice patients in nursing homes and private residences.

Passages is a fast-growing care network

Passages is a fast-growing care network based in Illinois

Passages declined to return numerous phone calls from Life Matters Media seeking comment. The hospice’s website makes no mention of Gillman’s legal troubles; the company’s official Twitter account continues to advertise their services.

“The complaint was brought only against Seth Gillman, not Passages,” said Katten Muchin Rosenman Partner Gil Soffer, who represents Passages, in a statement to LMM. “The period of alleged misconduct set forth in the complaint ended in January 2012, more than two years ago. The company continues to provide high quality care to its patients.”

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

If convicted of health care fraud, Gillman could face a penalty of 10 years in prison and a $250,000 fine. If convicted of obstructing a federal audit, Gillman could face up to five years in prison and a $250,000 fine.

Hospice is generally care provided in a patient’s home, but 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 over the last five years from 1.25 million in 2008, according to figures published by the National Hospice and Palliative Care Organization in the organization’s 2013 annual publication “Facts and Figures: Hospice Care in America.”