Hospice Patients Alliance: Consumer Advocacy


While the hospice's source of funds may be the last thing on your mind, hospices are businesses. The business end of hospice can affect the care your loved one receives. Hospices receive funds from government programs or private insurance, from donations made by the public or other corporations, and from grants donated by charitable foundations. Hospices are reimbursed by Medicare, Medicaid, or private insurance for care provided to the terminally ill.

Except for continuous around-the-clock home nursing care, which is paid for on an hourly basis, all other services are reimbursed on a per-diem basis. Hospices are not reimbursed on a fee for service basis: rather, hospices are paid, on a basis of how many days the patient is enrolled in the program and received services: the per-diem basis. In return for payment, Medicare, Medicaid and private insurance companies expect the hospices to provide all services which the patient and family need which are related to the terminal illness. The Centers for Medicare Services (CMS) regulations mandate that the hospice comply with the regulations.

And the per-diem basis of payment assumes that the hospice agency will actually provide those services; this payment system places much trust in the hospice management. However, fewer services provided to a patient results in more money retained by the hospice. Obviously, the system can reward fraudulent hospices with increased income while honest, dedicated hospices provide full services as required.

Donations to Hospices

While nonprofit hospices can solicit as well as receive charitable donations, for-profit hospices can only receive donations. After the death of their loved one, some families suggest making memorial donations to the hospice they used. This is a very significant source of funds to the hospice and helps to cover expenses incurred in running the hospice.

Nonprofit charitable hospices are supposed to provide hospice services to those persons who do not have coverage and cannot afford to pay for care. So when you donate to a nonprofit hospice, there is a greater likelihood that charitable hospice services will be provided.

When you donate to a hospice, you cannot be sure that donations made to the local hospice will actually be used for the purpose you designate. Even if you designate a purpose, there are legal tricks of the trade, or accounting, which can make it possible for a hospice to shift the donated money or other money to other purposes than what you wished. Although there are laws stating that restricted donations must be used for the purpose designated by the donor, certain recent court cases have challenged the strictness with which these laws are enforced. Practically speaking, the government does not always look into what a hospice may do with any donations.

While donating directly to a nonprofit hospice allows you to claim a charitable federal tax deduction, you can only be sure that your money is used for a particular purpose if you personally buy something and donate it to the hospice. Some hospices have several branch locations covering a large area. If you donate to one hospice, the management may take the money and transfer it to a completely different location...or it may use the money to help pay for unreasonably high salaries for executives.

For-profit hospices have no obligation to provide services to anyone who does not have coverage from Medicare, Medicaid or private insurance. They can turn people away and tell people to go elsewhere. If you do choose to donate to a for-profit hospice, just remember that the for-profit corporation may take that money and pay its Chief Executive Officer many hundreds of thousands of dollars each year in salary and benefits!

No Need to Ever Pay Privately for Hospice Services

Whether or not your loved one has Medicare, Medicaid or private insurance, you should never have to pay out of your own pocket for hospice covered services. If a hospice asks you to pay for private duty nursing out of your own pocket when there are uncontrolled symptoms, when you already have Medicare, Medicaid or private insurance, it is very likely committing health care fraud illegally! It is important that you report this to your regional U.S. Office of Inspector General and U.S. Attorney's office. Double-billing is a very real and despicable scam committed by rogue hospices taking advantage of the dying. Don't let this happen to you!

Charitable Provision of Hospice Services

If you do not have any coverage by Medicare, Medicaid or private insurance, a nonprofit hospice can provide services to you FREE OF CHARGE as part of its charitable mission. The nonprofit status of the hospice often requires it to provide charitable services. Find a larger nonprofit hospice if you have no coverage; the nonprofit hospices are dedicated to the mission of serving those in need.

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