SSA Benefits Online

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.