Hospice Care, False Claim
You primary doctor indicated that you have less than six months to live and you qualify for hospice care. A second doctor disagreed. If the second doctor proves correct, did your primary doctor committed fraud?
This is the very issue that the following court case is addressing: United States v. Aseracare, Inc. (16-13004); Court of Appeals for the Eleventh Circuit
Medicare Rule.
If you have Medicare Part A (Hospital Insurance) and meet all of these conditions, your hospice care cost may be covered:
- Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).
- You accept palliative care (for comfort) instead of care to cure your illness.
- You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness and related conditions.
Medicare won’t cover any of these once your hospice benefit starts:
- Treatment intended to cure your terminal illness and/or related conditions.
- Prescription drugs to cure your illness.
- Care from any hospice provider that wasn’t set up by the hospice medical team.
- Medicare doesn’t cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility.
- Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it’s either arranged by your hospice team or is unrelated to your terminal illness and related conditions.
SSA Benefits Online 