WASHINGTON — The federal government, extending its financial investigation of hospice programs to California, wants San Diego Hospice to refund $2.1 million to Medicare for 37 patients who outlived the normal six-month prognosis for dying people in terminal care.
Government auditors looking for fraud in the Medicare program are seeking more than $80 million in repayments from a dozen hospice programs across the country for patients who lived more than six months, the standard length of the hospice benefit.
The audit of the San Diego program, completed this week, was the first investigation in California in which the government is seeking repayment. The hospice officials are angry, claiming that the government is unreasonable in expecting them to have a perfect record of predicting death.
"We want to make sure people know we are not ripping off the government," said Dr. Laurel Herbst, the medical director of San Diego Hospice, a nonprofit organization. "I know it is the job of government auditors to find stuff . . . but this just isn't common sense."
The government strongly disagrees. "We want to make it clear we are not faulting anyone for guessing wrong," said George Grob, deputy inspector general for the Department of Health and Human Services, which conducted the audits.
In the disputed cases at San Diego and other hospices, the patients "did not have a prognosis of six months to live when they entered the hospice program," Grob said. He added that the program "is only available to those who are facing death within six months."
Therefore, the patients "were never eligible to begin with," Grob said.
The argument pitting the San Diego group and other hospice officials against the government auditors focuses on sensitive emotional and medical issues dealing with care of the dying.
Hospice officials claim that the auditors--and the doctors hired by the government as reviewers of patient records--do not understand hospice issues and the difficulty of predicting death with any degree of certainty.
"Unlike cancer patients, for whom hospice care generally does not extend the patient's life expectancy, good hospice care can and often does extend the lives of patients with non-cancer terminal diseases, including AIDS and end-stage organ diseases," Herbst said.
By asking for refunds, she said, the government "effectively punishes us for doing a good job."
