Hospice eligibility basics
Medicare hospice benefits require a physician certification that a patient has a terminal illness with six months or less to live if the disease runs its normal course. Patients elect hospice instead of curative treatment.
Enrolling patients who are not terminally ill — or keeping them on hospice too long — can yield false claims.
Common fraud patterns
Kickbacks to referring physicians or nursing homes, falsifying terminal diagnoses, providing curative care billed as hospice, and inflating levels of care are enforcement themes in public cases.
Who may witness fraud
Hospice nurses, medical directors, admission coordinators, and billing staff often see when marketing pressure overrides clinical judgment about eligibility.
Next steps
Document patterns lawfully and consult qui tam counsel if you suspect systematic fraud. Tips to MACs or OIG are alternatives that typically do not pay relator shares. This article is general information, not legal advice.