Miller Participates in Hearing to Identify Medicare Waste, Fraud, and Abuse

Washington, D.C. - Congresswoman Carol Miller (R-WV) and her colleagues on the Ways and Means Committee held a hearing to examine potential waste, fraud, and abuse within Medicare payment systems as well as the effect of fraud on Medicare providers and patients. During questioning, Congresswoman Miller discussed pervasive fraud within hospice and home health operations. A video and full transcript of Congresswoman Miller's questions and provided responses can be found below.

Congresswoman Miller began by highlighting the serious vulnerabilities in Medicare's fee-for-service system, emphasizing the exploitation of both taxpayers and vulnerable patients and the alarming consequences of fraudulent hospice enrollment that can deny individuals access to life-extending treatments. She then questioned the witness, Ms. Sheila Clark, President and CEO, California Hospice and Palliative Care Association, on the extent to which recent fraud enforcement efforts have addressed patient harm in addition to financial losses, and what further steps Congress and CMS can take to strengthen patient protections, improve oversight, and ensure beneficiaries can identify and exit fraudulent hospice arrangements.

"Both patients and taxpayers are paying the price for serious vulnerabilities in Medicare's fee-for-service system, particularly in hospice care.

As we've seen, hospice services account for a significant share of improper payments, and bad actors are exploiting these benefits not just to defraud the system, but to take advantage of vulnerable patients at some of the most critical moments in their lives.

What is especially alarming is that this is not just financial fraud, it is deeply personal, harmful, and destructive to the lives of the people who get caught up in these schemes. Once a patient elects hospice, Medicare generally stops covering most other treatments. Fraudulent hospice providers are enrolling individuals who are not terminally ill and those patients are effectively cut off from curative treatments that could extend their lives, or improve them.

We've seen reports of patients being unknowingly enrolled and trapped in hospice care, which prevents them from accessing cancer treatments, cardiac procedures, and other necessary things to improve their lives, other things they can use. This raises serious concerns about whether our current enforcement framework is adequately addressing the full scope of harm being done not just to the Medicare trust fund, but to the patients themselves.

Ms. Clark, are you aware of whether any of the recent fraud busts have included elements related to patient harm, not just the financial implications?" asked Congresswoman Miller.

"Yes. Some of the hospices and home healths that have been deactivated or their payments have been suspended, yes, I know the name. I know their names well. My colleague behind me from Senior Medicare Patrol, we know their names well.

And I have one beneficiary that I'm working with right now who is liable for three months of dialysis claims. I was able to get her off of hospice through the rapid disenrollment process that is working really well, but she still under that benefit period, she still owes. And they're, they're suing her to pay for her. They want her to pay for her own, her dialysis. She was signed up by an LA provider and she lives in Fresno. And that's like for, if you don't know California, that's like 300 miles away. So there is, I noticed the names and they're being suspended and I say suspend some more," responded Ms. Clark.

"Well, building on that, what more can Congress and CMS do to strengthen patient protection so that beneficiaries can more easily identify fraudulent enrollment, exit sham hospice arrangements quickly, and regain access to the care they need?" asked Congresswoman Miller.

"Okay, so the first thing is getting the word out. And I always use my colleagues from Senior Medicare Patrol guard your card. So giving the beneficiaries the information on when to and how to respond if something is going wrong. Like what Doctor Lin went through, we have to educate them. And we've done that with the Senior Medicare Patrol on hospicefraudprevention.com. We have a plethora of resources out there. We did hundreds of hours of listening sessions. So, the education is key to our Medicare beneficiaries. First and foremost, we have to do that. And then with CMS, we just need stronger guardrails and we need to work at both the state level and the federal level to come together and solve these problems. Because you have licensure, the state gives a license, and the federal government certifies that license. And we have to work collaboratively to make sure that these scammers are out of the system," responded Ms. Clark.

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