Hospice bad actors are turning their attention to a new target to boost their patient census and, in turn, revenue figures: opioid treatment programs (OTPs).
OTPs, otherwise known as methadone clinics, are able to prescribe and dispense medications such as methadone for the treatment of opioid use disorder (OUD). Unethical end-of-life care providers in California, in particular, are reportedly targeting homeless people and methadone patients, telling them they’ll receive opioids and more in exchange for enrolling in hospice.
Behavioral Health Business sister publication Hospice News recently reported on these illegal practices, drawing from interviews with multiple hospice providers who decry such practices.
“According to their reports, unscrupulous providers have canvassed both homeless encampments and methadone clinics seeking to sign up patients who are not terminally ill,” Hospice News wrote in an Aug. 23 report.
Often, sources told Hospice News, the bad actors will offer patients free access to board-and-care facilities and a daily supply of morphine. Another frequent practice among these hospices is to offer patients cash or other items in addition to drugs, sources told Hospice News.
The hospice industry has been in the spotlight for roughly three years for fraud, waste and abuse concerns.
Beginning in 2021, numerous reports emerged of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona.
California’s Department of Justice in 2021 issued a report detailing the state’s history of lax oversight.
Following these reports, federal regulators and some states, including California, said they would stop certifying new providers in red-flag markets. Reporting in 2024 from Hospice News and other newsrooms suggests these efforts have not yielded the desired results, however.
The problems have been so pronounced that HBO satirical news program Last Week Tonight with John Oliver highlighted the topic on Aug. 19.
The predatory behavior around OTPs and medication-assisted treatment (MAT), though, had been previously unreported.
Hospice industry leaders have strongly condemned such actions.
“This conduct raises serious fraud concerns on kickbacks or gifts to beneficiaries who do not appear to qualify for hospice,” Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), told Hospice News. “More importantly, this conduct is predatory, taking advantage of individuals in addiction. Jail time is not enough punishment for the harm that such conduct creates.”
One executive described the practice as being carried out by someone who owns several hospices and board-and-care homes.
“They get homeless patients from methadone clinics and tell them, ‘Just come and live at the house, and we’ll give you constant morphine; we’ll give you a constant supply,’” the hospice executive told Hospice News. “They have continuous care nurses who are there all the time and they basically keep patients on high-dose morphine.”
Board-and-care homes are designed for older adults or seriously ill patients who need assistance with activities of daily living and prefer to live in a smaller community than a larger senior living facility. They are often located in residential or rural areas. In some states, but not all, these services are covered by Medicaid.
In the Hospice News report, sources alleged that many of these patients, before enrolling in hospice, had been receiving methadone treatment for OUD.
As of 2022, an estimated 9.4 million U.S. adults needed OUD treatment, and about 55% of those received it, according to the U.S. Centers for Disease Control and Prevention (CDC). The need for treatment was higher among patients who live below the poverty level, CDC reported.
Giving patients with OUD access to morphine leads to resurgent addiction, serious side effects and in some cases death, according to one hospice executive, who told Hospice News they were concerned that deaths due to overdose in these board-and-care facilities could be disguised as terminal illness. The scheme might depend in part on such patients dying on a timeframe that allows the hospice to manage its payments within cap limits.
“It’s like a pyramid scheme,” an executive told Hospice News. “They are constantly in this situation: ‘We need more patients, and we need patients that are going to die.’”
Original story and reporting by Jim Parker, senior editor, Hospice News.
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