LAS VEGAS (KSNV) — Federal and state officials are ramping up efforts to combat hospice and home health fraud in Nevada, as regulators and providers warn that a surge in new companies has created opportunities for patient neglect and theft of public funds.
Assistant Attorney General Colin McDonald of the Justice Department’s Fraud Division described the mission of a new West Coast strike force involving Arizona, Northern California, and Nevada.
“If you steal from the American taxpayer, the Department of Justice and our law enforcement partners will do everything possible to award you free housing in a federal prison,” McDonald said.
About a month after the strike force was announced in April, Governor Joe Lombardo issued a pause on state licensure of hospice and home health providers.
“Bad actors who use hospice and home-health programs as vehicles to steal public funds are undermining care for those who need it most,” Lombardo said.
Karen Rubel, president and CEO of Nathan Adelson Hospice, said the rapid growth in providers has raised concerns about quality and accountability for patients near the end of life.
“It’s people at their most vulnerable, like the people in our community, should not be taken advantage of or be getting poor care when they’re hospice appropriate, when they’re in the last six months of their lives,” Rubel said.
Rubel said that from 2022 to now, Clark County went from about 30 hospice providers to 300, after California officials put their own moratorium on hospice care
“And that drove everybody who wanted to start a hospice to Nevada, Arizona, and Texas,” she said.
The investigation includes multiple state and federal partners, including the Nevada attorney general’s office.
In a statement released after the strike force announcement, Attorney General Aaron Ford said, “As the person who actually won back $40.9 million and dozens of convictions cracking down on Medicaid fraud for Nevada, let me set the record straight… Joe Lombardo is using Medicaid fraud to justify his despicable political ploy of taking away dying Nevadans’ health care to appease Donald Trump.”
Nevada First Assistant U.S. Attorney Sigal Chattah said Nevada faces three main issues when it comes to fraud: “Patient neglect, false claims, and kickbacks.”
Rubel said her organization has heard directly from patients experiencing problems while enrolled in hospice care.
“Patients were calling us because they were on hospice, but they weren’t seeing a nurse, they couldn’t get their medication, they couldn’t get their durable medical equipment, all kinds of issues,” she said.
Rubel said the hospice industry has not experienced this level of market saturation before and that providers raised concerns with government officials after concluding fraud was driving the expansion.
“We want to make sure we are doing all the best practices that we can at the bedside, but it’s these other folks that kind of fly under the radar; they need to be held accountable as well,” she said.
Rubel said fraudulent hospice providers may keep their clientele small to avoid reporting quality scores and Medicare audits.
She also said that when providers face scrutiny, they may transfer a Medicare account to a family member to continue operating.
The Nevada Health Authority has said Medicaid losses can be nearly impossible to recover because stolen payments are often diverted to offshore accounts.
Nevada Medicaid is allowing some new providers to apply for an exemption if they are providing support for improved access to hospice and home health care in rural and underserved communities.
During the six months, the moratorium will not affect:
– Medicaid eligibility for recipients
– Medicaid coverage for hospice and home-health services
– Hospice and home-health providers enrolled in, and in good status with, Nevada Medicaid including those in the revalidation (renewal) process for enrollment
– State-licensed providers who are up for renewal of their state licensure*
– New hospice and home-health providers who have submitted an application for state licensure in Nevada prior to the effective date of the moratorium*
– New hospice or home-health providers who receive an exemption from the moratorium from the Nevada Health Authority because they are addressing gaps in care in an underserved area of the state*