New York Times sniffs out fraud in hospice

A widely syndicated New York Times article in May used fraud allegations against Samaritan Hospice Care, of Lansing, IL, and its former owner, Joseph Kirschenbaum, to tar the entire hospice industry. (See last month's Hospice Management Advisor, p. 74-75)

"Hospice boom is giving rise to new fraud," by Douglas Frantz, purports to demonstrate "how easily people can maneuver within the Medicare system to commit multimillion-dollar frauds." Hospice is described as the fastest growing segment of the federal Medicare budget, ". . .but as specialized care for people on the brink of death has boomed, so has a new brand of fraud and abuse that is straining a regulatory system that was never designed to handle the expanding network of nursing homes, assisted care centers and other services popping up to serve the nation's growing aging population."

The National Hospice Organization (NHO) immediately responded with a letter expressing outrage at "the unfounded implication that the Kirschenbaum case is representative of hospice care." The Times article emphasized problems for hospice in the nursing home, the setting where Kirschenbaum's program operated and the target of recent probes by the Office of Inspector General. The NHO's letter points out that its nursing home task force recently completed guidelines to clarify the respective roles of nursing facilities and hospices in sharing the care of dying patients. This report, approved by the NHO's board of directors in late April, should be released soon. (See p. 92 of this issue.)

"We share your anger about the alleged actions of one individual; it is our position that anyone found guilty of intentionally defrauding the Medicare system should be prosecuted to the fullest extent of the law. However, it will be unpardonable if allegation and innuendo about an atypical circumstance create barriers to hospice care," the NHO's letter states.

Ira Byock, MD, program director of the Robert Wood Johnson Foundation's program Promoting Excellence in End-of-Life Care, was even sharper in his critique. "This ran all over the country under the headline, `Fraud grows as hospice expands.' I'd say Douglas Frantz got his story 180 degrees wrong. He talks about Kirschenbaum in a way that makes it very much look like fraud is epidemic in hospice. If indeed the allegations are true, the Samaritan was a bald case of fraud. What does that really say about the industry as a whole?" Byock asks. "But it softens the blow for the Clinton administration to take the hospice benefit away from the nursing home."

Meanwhile, back in Illinois, Illinois State Hospice Organization executive director Pam Kanies says she is not hearing any repercussions for other hospices from the Samaritan case. "We're aware of the New York Times article. Our census and our length of stay are dropping, but it's not any different than the rest of the country," she says. "People who have relationships with hospices know that this kind of case is so uncommon. But I have gotten a few calls from different groups of people who seem to have concluded that hospice is now the field to get into," Kanies says.