LAS VEGAS (KTNV) — Hospice administrators, clinicians and healthcare advocates gathered Wednesday to discuss a growing problem inside an industry meant to provide comfort at the end of life — and what providers say must change to protect patients.
WATCH | Abel Garcia sat in on the meeting to learn more:
The meeting comes as Nevada and federal officials intensify efforts to crack down on suspected fraud within the hospice industry. The Nevada Health Authority recently announced a pause on new hospice licenses and new Medicaid enrollments while the state investigates fraud concerns and verifies existing providers.
The move follows years of increased scrutiny. In 2023, the Centers for Medicare and Medicaid Services placed Nevada under what it calls "enhanced hospice oversight" due to an increase in fraud, waste, and abuse.
Sarah St. John, director of clinical services at Unified Care Hospice, said the root of the problem comes down to motivation.
"Money. People see hospices as a business and a way to make money, and they get into it, I think, for the wrong reasons," St. John said. "These patients become numbers, they become dollar signs, and the greed takes over."
Dr. Timothy Beckett, CEO and founder of Unified Care Hospice, said the consequences for patients are serious.
"The large majority of the patients, I can honestly say, are not getting the care they need because they end up in hospices that they shouldn't be," Beckett said.
Beckett said the problem reflects a deeper, long-standing failure within the industry.
"Fraud has always been there. We've just never had the resources to truly go and investigate it to the degree that we need to," he said. "More importantly, we need to create more barriers to opening up hospices in the first place."
Rick McCann, a lobbyist and government affairs director working with the coalition, said the issue is also tied to how Nevada regulates new business growth.
"You have a ripe and fertile field. We can create businesses and nobody's going to go out of their way every two years legislatively to worry about regulating us," McCann said.
Coalition members said they are working with Assemblywoman Dr. Rebecca Edgeworth, a practicing physician, on possible legislation aimed at strengthening hospice licensing and oversight. The group is also developing a reporting tool designed to help track suspected fraudulent activity and share information with investigators.
St. John said educating the public is also a critical part of the solution.
"Have some sort of checklist or educate the public on things they need to ask these hospices to see that they're going to a good hospice, because hospice is an amazing gift, an amazing tool," St. John said.
I reached out to the governor's office with questions about the meeting and was directed to the Nevada Health Authority. Below are the answers to my questions:
What specific findings or evidence led the administration to support the recent licensing and enrollment pause?
"Although the state cannot speak to the details or specifics of cases under investigation by the Office of Medicaid Inspector General, the Centers for Medicare & Medicaid Services (CMS) identified Nevada as a state with an 'elevated fraud risk' for hospice providers.
"We can confirm that there has been a rapid increase in licensure and enrollment for these providers over the last several years in addition to fraudulent practices."
How widespread does the administration believe hospice and home-health fraud is in Nevada?
"Given the recent uptick in investigations of credible allegations of fraud within Nevada, the state believes that this moratorium is necessary to avoid losses of scarce taxpayer dollars that fund these lifesaving health care programs."
What steps are being taken to protect patients and families while these investigations continue?
"Conducting site visits and checking these facilities helps protect patients and families by helping identify bad actors and unsafe facilities. This work will be coordinated with our state licensing team to address any safety or care issues identified in the process."
Does the Governor support additional legislative reforms to strengthen hospice licensing requirements and oversight?
"We cannot speak to legislative reforms at this time until we finalize the reviews of these existing facilities and providers."
What outcomes does the administration hope to achieve through these actions?
"Our goal is to ensure taxpayer dollars intended for Nevada Medicaid are being utilized safely and properly by legitimate providers delivering safe, high-quality care to Nevadans who need it. By strengthening Medicaid fraud prevention and detection efforts, we deter bad actors from taking advantage of this system, protect vulnerable Nevadans, and preserve scarce taxpayer dollars. Ultimately, these efforts contribute to the ongoing preservation and integrity of the Nevada Medicaid Program."
