DOJ announced a $12 million settlement with Hospice of Arizona along with American Hospice Management, LLC, and their parent corporation, American Hospice Management Holdings, LLC, for claims involving Medicare fraud and the False Claims Act.  The allegations involved submitting or causing the submission of claims to the Medicare program for ineligible hospice services provided by Hospice of Arizona.   The government alleges that Hospice of Arizona and its related entities engaged in certain practices that resulted in the submission of false claims, including pressuring staff to meet admissions and census targets, adopting procedures that delayed and discouraged discharges of ineligible patients, and failing to timely implement an adequate compliance program.
"The Medicare hospice benefit is available for patients who elect palliative treatment (medical care focused on providing patients with relief from the symptoms, pain and stress of a serious illness) for a terminal illness, and have a life expectancy of six months or less if their disease runs its normal course. Today’s settlement resolves allegations that Hospice of Arizona and its related entities submitted or caused the submission of false Medicare claims between September 1, 2002 and December 31, 2010 for Hospice of Arizona patients that did not have a terminal prognosis of six months or less, or that did but were not eligible for the level of care billed."


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ElderBranch issued a press release about palliative care at nursing homes.  Nursing homes largely do a poor job when it comes to palliative care today.  According to the Center to Advance Palliative Care, half of nursing home residents suffer from untreated pain. Comfort care and symptom management are lacking and hospice is under-utilized. With as many as 25% of people passing away in a nursing home setting, high quality support and care for the dying is critical in these environments.

Dr. Temkin-Greener, of the University of Rochester Medical Center, cites the lack of nursing home-specific palliative care practice guidelines, inadequate staff education and the failure to integrate palliative care practices into regular care as some of the key barriers to nursing homes offering high quality, comprehensive palliative care today.

ElderBranch is an online information portal that helps people find and evaluate long-term care providers. ElderBranch’s mission is to support users in making the best decision possible for themselves and their loved ones.


Harmony Hospice Care, a South Carolina hospice company owned by Daniel J. Burton will pay the federal government nearly $1.3 million in a settlement with DOJ for filing false claims to Medicare.  Harmony Hospice Care was filing claims for hospice care under Medicare for patients who did not qualify.  Harmony Hospice Care has locations in Columbia, Greenville, Hartsville and Union.

Two employees, Mona Singletary and Lynda Fulton, sued the company and Burton under a whistleblower provision of federal law. That law allows private citizens to sue on behalf of the federal government and receive part of any penalties defendants must pay. Singletary and Fulton will split about $245,000.



The Afterlife Education Foundation (AEF) will host its Third Annual Afterlife Awareness Conference June 21 – 23, 2013 in St. Louis. The conference will feature workshops and presentations by a nationally-recognized consortium of researchers, educators and counselors in the fields of thanatology, bereavement, theology and paranormal studies.


The conference was organized to meet the need for a national discussion on the metaphysical aspects of death, dying and bereavement, including after-death communication, out-of-body experience, near-death experience, hospice care and grief processing. This year’s roster of presenters includes some of leading names in the field, including Dr. Raymond Moody, author of the breakthrough book, Life After Life; neurosurgeon Eben Alexander MD, (recently featured on the cover of Newsweek magazine); Dr. Ken Doka, senior consultant to the Hospice Foundation of America, and many other noted luminaries in end-of-life care and afterlife research. The conference will also include presentations and gallery-style readings by several acclaimed psychic mediums.


“This conference is an extraordinary opportunity to look at death and bereavement in a new light,” explains Terri Daniel, president of the Afterlife Education Foundation, the non-profit educational organization that sponsors the yearly event. “Our audience is made up of hospice workers, scientists, therapists, clergy, spiritual seekers, the bereaved and the curious. We’ve all found, throughout our years of practice, that understanding how consciousness continues after the death of the body is a key to providing wisdom and comfort for the bereaved and overcoming the fear of death.”


Detailed information on the conference can be found at


For media inquiries or to arrange an interview with conference principals or presenters, please contact Terri Daniel at 541-549.4004 or


WHAT: The Third Annual Afterlife Awareness Conference

WHERE: The Sheraton Westport Plaza Hotel, St. Louis, MO.

WHEN: June 21 – 23, 2012

CONTACT: – 541- 549-4004


The Daily Beast had a great article on the cost of dying in America using one family’s story as an example.  The article is adapted from Amanda Bennett’s book, The Cost of Hope: A Memoir.

$33,382 for one hospital stay. $43,711 for the next. And a final $14,022 for the last three days of life. Across the country, sick people are paying hundreds of thousands of dollars for “comfort care” at the end of their lives. The expensive scans, tests, and treatments that dying patients receive often provide a false hope, and at the end of it, many are surprised to suddenly learn they will still die. The incentives are skewed. “Hospitals and doctors are paid only for what they do, not what they don’t do,” Bennett writes. She reports on the high cost of staying alive living and why the notorious “death panels” may be just what patients need.  31 percent of health-care spending is on paperwork.

"Shannon Brownlee, in her book Overtreated, argues that the increased use of scans has done little to improve the accuracy rate of diagnoses, which has remained about the same for more than a century. In fact, says Dr. Elliott Fisher, a professor at Dartmouth University’s Geisel School of Medicine who has studied end-of-life spending for nearly 30 years, even places that spend twice as much on treatments as others do no better at extending life—and may even make things worse. Indeed, as far back as 1998, two researchers, Jonathan Skinner and John Wennberg, wrote for the National Bureau of Economic Research (a private nonprofit research group) that as death approaches, neither high spending nor days in the hospital or intensive care seemed to have much to do with how long you lived."

The Health Blog on the Wall Street Journal’s website had an interesting article on cutting health care costs and providing better care in the process.  "A better approach to advanced illness, including fewer hospitalizations, could improve quality of life and satisfaction for the sickest patients — and save $25 billion in annual health-care costs, according to Gundersen Health System.  Gunderson advocates helping patients and families prepare for end-of-life decisions, and avoiding unwanted treatments while providing comfort and pain relief.

Gundersen’s Respecting Choices program is a model for how hospitals, insurers, and patients and their families can work together to make sure people with advanced illness get the quality of care they want and have their wishes for treatment respected.

Part of the program includes having patients and physicians fill out a form known as a POLST — for Physician Orders For Life Sustaining Treatment. This is an initiative that lets people with advanced illness nearing the end of life make decisions such as whether they want life-sustaining treatments on a mechanical breathing machine.



Kaiser Health News reported the disturbing but all too common story of Medicare fraud involving hospice and nursing homes.  A whistleblower accuses AseraCare of improperly cycled patients through nursing homes and hospice with a goal of making as much profit as possible from Medicare.  Federal attorneys also sued alleging it milked Medicare’s hospice benefit by pressuring its employees to enroll people into hospice who weren’t dying and resisted discharging them despite evidence they weren’t deteriorating. 

Critics of Medicare’s hospice benefit have said that the way the government pays providers gives them financial incentives to abuse the system. AseraCare, a Fort Smith, Ark.-based hospice company operating in 19 states.  The company is owned by Golden Living, a national for profit chain that operates nursing homes.

The whistleblowers contend that AseraCare first recruited patients eligible for skilled nursing care –also provided by Golden Living— for 20 days, for which Medicare pays the entire bill. After 20 days, when Medicare requires patients pick up a part of the tab, AseraCare had the nursing homes send the patients to hospice, according to the lawsuit. In hospice, AseraCare would collect a flat payment from Medicare for each day they are enrolled.  AseraCare sent employees to “patrol hospitals,” ride along with “Meals-on-Wheels” and go “door-to-door” in housing run by the Department of Housing and Urban Development, according to the lawsuit brought by the whistleblowers, who are represented by Birmingham attorney, Jim Barger. In a separate suit settled in 2009, Barger won the largest settlement in a hospice care case against SouthernCare, and is also representing whistleblowers suing Vitas HealthCare.

“Typically, a patient admitted into Defendant’s web of operations will be referred and re-referred until that patient has received—and Medicare has been billed for—the maximum number of days of skilled nursing care, including rehabilitative therapy … home health care, and hospice care,” says the lawsuit, brought by Dawn Richardson, an AseraCare nurse manager, and Marsha Brown, who ran several AseraCare offices in Alabama.


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Business Week and The Washington Post both had interesting articles on the profitable hospice industry.  Nursing homes often push hospice on residents who are not terminal.  The nursing home then relies on the hospice employees to take care of the resident.  Medicare-paid hospice include visits from a nurse and chaplain, plus an extra weekly bath.  Much better than typical Medicaid paid services for nursing home residents. The government often pays twice for hospice patients in nursing homes — about $137 a day to the hospice provider from Medicare, and about $200 a day to the nursing facility from Medicaid, which covers the indigent elderly.

Hospice care has become a growth industry, with $14 billion in revenues, 1,800 for-profit providers and a base of Medicare-covered patients that doubled to 1.1 million from 2000 to 2009.  "Compensation based on enrollment numbers, pay to nursing- home doctors who double as hospice medical directors and gifts to the nursing facilities have helped fuel the boom, according to an examination of 1,000 pages of court documents and interviews with more than 45 current and former hospice employees, patients and family members."

Publicly traded companies have created hospice chains through serial takeovers in the last decade. Hospice buyouts and investments by for profit private-equity firms have led to inflated enrollments and unnecessary expense.  There are allegations that bribes and kickbacks are used for referrals.  Nursing homes have been offered diapers, wheelchairs, nutritional supplements and other supplies in return for patient referrals. Under various federal statutes, paying for patient referrals or compensating employees based on the number of Medicare patients recruited is illegal but enforcement is nonexistent. 

Under Medicare rules, patients are only eligible or hospice if two doctors certify that they have six months or less to live. They can stay on hospice indefinitely if a doctor recertifies their terminal illness every 60 days.  Doctors sign off on whatever the nursing home says because they are the "eyes and ears" for the doctors.

The inspector general of the Health and Human Services Department is finally investigating hospice marketing practices and financial relationships with nursing facilities. The inquiry was prompted by a 2009 report by the Medpac commission, a congressional advisory body, that found hospices “aggressively marketed” to nursing-home patients, and paid incentives to medical directors for “inappropriate” referrals and enrollments.

The Stark Law is designed to ensure that doctors refer patients based on who provides the best care, not based on who is paying them.  However, seven pending or settled lawsuits against hospice companies say that enrollment-based incentives led to admitting patients who didn’t qualify for hospice care.

The rise of for-profit hospice care since 2000 has helped drive a 60 percent increase in the average time patients spend in hospice, to 86 days in 2009, according to Medpac. The average stay of the 10 percent of patients who remained in hospice the longest soared 71 percent to 240 days. That means at least 110,000 patients weren’t facing imminent death when they were admitted.  Profit margins on healthier patients who survive for years with minimal care can exceed 20 percent, according to Medpac. 



The New York Times recently ran an incredible article by Jane Gross who is a former New York Times reporter and the author of “A Bittersweet Season: Caring for Our Aging Parents — and Ourselves.”   Below are excerpts:

HERE is the dirty little secret of health care in America for the elderly, the one group we all assume has universal coverage thanks to the 1965 Medicare law: what Medicare paid for then is no longer what recipients need or want today.

No one then envisioned the stunning advances in medicine that now keep people alive into advanced old age, often with unintended and unwelcome consequences. Indeed, scientific reports have showed the dangers, not merely the pointlessness and expense, of much of the care Medicare is providing.

Of course, some may actually want everything medical science has to offer. But overwhelmingly, I’ve concluded in a decade of studying America’s elderly, it is fee-for-service doctors and Big Pharma who stand to gain the most, and adult children, with too much emotion and too little information, driving those decisions.

In the last year alone, and this list is far from complete, here is what researchers have found both useless and harmful, according to leading medical journals:

Feeding tubes, which can cause infections, nausea and vomiting, rarely prolong life. People with dementia often react with agitation, including pulling out the tubes, and then are either sedated or restrained.

Abdominal and gall bladder surgery and joint replacements, for those who rank poorly on a scale that measures frailty, lead to complications, repeat hospital stays and placement in nursing homes.

Tight glycemic control for Type 2 diabetes, present in 1 of 4 people over 65, often requires 8 to 10 years before it helps prevent blindness, kidney disease or amputations. Without enough time to reap the benefits, the elderly endure needless dietary limits and needle sticks.

Yet Medicare, which pays for all of the above, does not, except in rare instances, pay for long-term care in a supervised, safe place for frail or demented old people, or for home aides to help with shopping, transportation, bathing and using the toilet.

Nationwide, the median annual cost of a nursing home in 2010 was $75,000; room and board in an assisted living facility, with no additional help, was $37,500; and the most basic category of home health aide, who can perform no medical tasks, like the dispensing of medication, was $19 an hour. These expenses are left to the elderly (and their adult children) to pay for out of pocket until their pockets are all but empty.

A recent state-by-state study of long-term care, the first of its kind, by a consortium of researchers, has found that this kind of essential help costs anywhere from 166 percent to 393 percent of the average annual income of America’s elderly.

This mismatch between what is covered and what is actually useful is the central flaw in Medicare today, a shock to families who have no clue, until they’re smack in the middle of it, about how this system works.

This mismatch tortures our elderly, drains the Medicare trust fund and leaves adult children with depleted retirement reserves. Yet in all the debate about the national debt, medical inflation and the need to pare Medicare costs by such means as raising the eligibility age, why is nobody, outside the insular community of long-term care providers, even mentioning the difference between acute and chronic care and how each is paid for (or not)?

The current system is unsustainable, but the alternative is the third rail of health care policy. President Obama’s original legislation included Medicare reimbursement to doctors for discussion of end-of-life issues. These are what Sarah Palin called “death panels”; days later, they were cut from the legislation. An Independent Payment Advisory Board will make recommendations to Medicare about what works and what doesn’t, beginning in 2015, but its proposals are not binding, as intended. A long-term-care insurance provision — with an average daily benefit of a mere $50 — is under siege.


USA Today had two related articles recently about the high cost of hospice and how for profit chains have manipulated the Medicare reimbursement rules to generate incredible revenue.  Medicare costs for hospice care have increased more than in any other health care sector as for-profit companies continue to gain a larger share of the end-of-life medical market.  From 2005 through 2009, Medicare spending on hospice care rose 70% to $4.31 billion.

A recent report by the inspector general for Health and Human Services, which oversees Medicare, found for-profit hospices were paid 29% more per beneficiary than non-profit hospices. Medicare pays for 84% of all hospice patients. At the same time, some of the nation’s largest for-profit hospice companies are paying multimillion-dollar settlements for fraud claims and facing multiple investigations from state and federal law enforcement agencies while lobbying Congress to pass tort reform and increase reimbursements.

Critics say costs have also increased because for-profit organizations have cherry-picked patients who live the longest and require the least amount of care — such as those with dementia or Alzheimer’s, rather than those with cancer. From 1998 to 2008, Alzheimer’s and dementia hospice cases grew from 28,000 to 174,000, reports the Medicare Payment Advisory Committee (MedPAC), an independent commission that advises Congress. The inspector general’s report said 90% of those patients lived in nursing facilities when they entered hospice care.

Medicare paid hospices that operated out of nursing facilities in excess of $3,000 more per beneficiary on average than it paid other hospices.   MedPAC found that amont the hospices that exceeded the spending cap, 44% of patients transferred back to traditional care from hospices exceeded the six-month spending cap. That suggests "above-cap hospices may be admitting patients before they meet the hospice eligibility criteria," it said in its 2011 report to Congress.

Meanwhile, the nation’s two largest for-profit hospice companies, Vitas and Gentiva, have together spent $1,188,100 on lobbying this year, records show.  In the first half of 2011, Vitas paid $390,000 to Washington lobbyists, according to lobbying reports. The company receives 90% of its revenue from Medicare and Medicaid, according to its filings with the Securities and Exchange Commission.  Gentiva spent $798,100 in the same time period on lobbying.

Both companies face a series of fraud investigations by state and federal law enforcement agencies, and have paid multiple fines.

Meanwhile, the trade groups representing hospice companies have formed the Hospice Action Network.

A 2005 study in the Journal of Palliative Medicine found that large, publicly traded for-profits had profit margins nine times higher than large non-profits. In 2010, Gentiva collected $326.2million from Medicare for hospice care, compared with $68.8 million in 2009, according to SEC filings. That’s in large part because it has been buying smaller hospices.

Vitas has also been growing: In 2008, its revenues were $808.4 million, and in 2010, $925.8million. It projects an annual increase in admissions of between 5% and 7%.