Complaint·July 29, 2022

Regarding the allegation: Facility is inappropriately referring residents to a hospice service. It was alleged that the facility regularly accepts patients that are not at ‘end of life’ and refers them to receive hospice care so that the facility can receive a higher payment. As of 7/29/2022, out of 61 residents that reside at the facility, only 16 residents are receiving hospice services at this time. The facility has an approved hospice waiver to have up to twenty (20) residents on hospice at one time. It was communicated that some residents have lived at the facility for an extended period of time and due to a natural decline, were recommended to receive hospice services by their primary care physician. Staff said that residents can also be admitted to the facility with hospice care. Staff confirmed that they are unable to refer a resident to receive hospice services, as they are not medical professionals and that decision is to be made in collaboration with the resident’s responsible party and the prescribing medical professional providing care for the resident. Interviews with family members of residents whom receive hospice services confirmed that the resident was referred to hospice by either the resident’s primary care physician or admitting physician in the hospital, and that it was not the decision of the facility administration. This facility has an in-house hospice agency named Spirit Healthcare Hospice. However, further review confirmed that this facility provides family members with a form entitled “Hospice Agency Informed Choice”, which is a list of available local hospice agencies to aid in the family’s choice in choosing the best fit for the resident in question. Family interviews confirmed that they were never persuaded or forced to choose the facility’s internal hospice company. A review of the list revealed that there are at least ten (10) listed hospice companies listed on the form. A review of the resident roster confirmed that there are currently at least four (4) different hospice agencies providing hospice services to residents in this facility. Based on the information obtained, there is insufficient evidence to support the claim that the facility is inappropriately referring residents to a hospice service. This allegation is Unsubstantiated at this time. Regarding the allegation: Facility is inappropriately billing residents. It is alleged that once a resident is placed on hospice, the facility will accept or require an additional fee from the resident’s family ‘off the books’. Interviews confirmed that the board and care rate for residing at this facility is a standard rate, and the rate does not increase if a resident is placed on hospice. The facility stated that the board and care rate covers the basic services for the resident, and is separate from hospice care, as that is billed and covered through Medicare. Staff reiterated that they do not require an extra charge or an increase in rate due to a higher level of care for any resident receiving hospice care. Staff denied claims that they ever received any cash payments or supplementary payments from families. Interviews with family members of residents whom currently receive hospice services confirmed that the facility did not increase the resident’s rate once the resident was placed on hospice, and denied claims that the facility has asked for any additional payment ‘off the record’. Based on the information obtained, there is insufficient evidence to support the claim that the facility is inappropriately billing residents. This allegation is Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.