Hospice Medicare Fraud: Enrollment and Billing Red Flags

Medicare hospice eligibility requires certification of a terminal prognosis of six months or less if the illness runs its normal course. The election concerns hospice care for the terminal illness and related conditions.

Living longer than six months does not automatically end eligibility or establish fraud. CMS permits further benefit periods with the required recertification. The relevant question is whether the clinical evidence and certifications support the coverage billed.

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.

Hospice nurses, medical directors, admission coordinators, and billing staff often see when marketing pressure overrides clinical judgment about eligibility.

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.