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Tipsheet

Dr. Oz Sounds the Alarm About Another Type of Fraud in CA

Dr. Oz Sounds the Alarm About Another Type of Fraud in CA
AP Photo/Evan Vucci

Following revelations of massive Medicare/Medicaid fraud in Minnesota, we're not surprised that other states have fraud problems, too. California, unsurprisingly, is one of them. Dr. Oz, head of the Centers for Medicare & Medicaid Services, is now revealing that the fraud even affects California's hospice program.

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Hospice is designed for patients who are facing terminal illnesses with a life expectancy of less than six months. The focus of patients, their families, and the healthcare providers is quality of life and comfort, which means symptoms related to the terminal illness (e.g., pain, nausea) are managed, but the terminal illness isn't treated.

Dr. Oz says doctors are being paid to send patients to hospice inappropriately.

"They realized that they could pay doctors to move people into hospice," Oz said. "The hospice is designed for the last six months of your life. It means you're going to die. These hospice programs are created when the most common reason that you'd enter it is cancer. But these days, not everyone with cancer dies, but also you're putting a lot of people with Alzheimer's and other conditions in there. So it became a little harder to police."

"But what happens if 100 percent of the people in hospice survive six months?" Oz asked. "Like, nobody dies."

According to Medicare rules, hospice patients must be evaluated periodically to continue qualifying for hospice. For new hospice patients, there is an evaluation at 90 days and again at 180 days. After that, patents are reevaluated for certification every six months. According to Medicare, hospice patients spend about 92 days on average on hospice services.

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"Doctors are being paid to send people in appropriately into hospice. Now that's a problem...because if you're put into hospice, you actually give up the rest of your healthcare protection. You no longer get traditional Medicare benefits because you're in hospice, you're dying," Oz continued, "so we're not going to pay all these extra expenses for things that aren't going to benefit you, because you've decided to pull back. Voluntarily, you decided that you're not going to go out there and try to get everything done for you, possible to help you live longer. You've made peace with the end."

"But people are put on hospice who don't know it, they don't realize it," Oz said. "And so now they don't have access to regular Medicare anymore, so people are dying because they can't get care because they were falsely tricked into being on hospice."

"That's a major concern for me, but then I began to look into how this could possibly happen," Oz went on. "How is it that we've gotten seven times more hospice in California over the last several years? Do we have seven times more people dying? What's going on here? And we began to realize it's systemic fraud. Everyone decided not to do anything about this. We're not going to look at it; it's too painful, too difficult. Maybe some groups may benefit financially from not checking into this. The doctors are getting engaged so much in hospice that it's beginning to undermine basic ethos of the healthcare profession."

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Dr. Oz said the fraud is "more rampant in California than you can imagine" and estimates billions of tax dollars are lost to fraud.

This is an issue that must be addressed, including the reasons why doctors are putting patients in hospice without the patient's knowledge or consent.

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