Jordan Rau of Kaiser Health News has turned a sharp eye on for-profit hospices during the past year, writing about allegedly abusive practices detailed in whistleblower lawsuits.
The whistleblowers – former company insiders – claim that some operators are enrolling patients in hospice care inappropriately in an attempt to maximize Medicare revenues. Lawsuits have been settled out of court, and companies haven’t admitted any wrongdoing.
Here, Rau explains how he came upon the trail of his New York Times story and pursued it, with a few twists and turns, over the course of several years.
By Jordan Rau
For several years, my running joke with editors was that my effort to write about hospice was taking so long that by the time I published an article I would myself need hospice services.
I first became interested in for-profit hospices back in 2008, when I was at the Los Angeles Times and had taken a week for a fellowship at the International Longevity Center-USA. It turned out the growth of for-profits in the industry had been documented before, including terrific 1998 articles by Charles Babcock in The Washington Post and Charles Ornstein in The Dallas Morning News. For years, the Medicare Payment Advisory Commission had been detailing their concerns about the perverse incentives Medicare’s hospice payment system. So the challenge was to bring something new to the discussion.
While at the Times, I started looking at whether for-profit hospices in California had worse safety records than nonprofits. I started collecting Statement of Deficiency reports, known as 2567s, that are put together by the Centers for Medicare & Medicaid Services. Some were pretty amazing, such as one where a patient with Alzheimer’s set himself on fire while smoking a cigarette on the patio of a nursing home. Most documented recordkeeping errors such as “lack of a plan of care” that, while indicating more substantial problems, didn’t on their own provide for compelling journalism. And none include the names of patients.
I also looked for civil malpractice lawsuits. Those are a rich source for stories on hospitals and nursing homes, but there aren’t many malpractice lawsuits brought against hospices, since the fact that most of the patients are dying limits the opportunities for large damages, and thus are less enticing for a plaintiff’s lawyer.
In 2009, I moved to Kaiser Health News. At about the same time, the government announced a $24.9 million settlement against SouthernCare, a for-profit hospice company. I started reading other “qui tam” whistleblower lawsuits that had been filed against hospices by former employees. Because these employees stood to gain a share of any damages recovered for the government, some of these lawsuits had a great deal of rich information, including internal company reports and documents compiled by the whistleblowers. The fact that the government joined in some of the cases also gave them more credibility than a regular lawsuit. And both the plaintiffs’ lawyers and the whistleblowers themselves were able and willing to talk knowledgeably. Some reports by the Inspector General of the Department of Health and Human Services, which has been looking into hospice fraud for more than a decade, also were helpful.
In 2010, I was still learning about the hospice industry and doing a lot of stories not related to hospice, and wasn’t ready to write my piece. I took a detour to write a piece for The Philadelphia Inquirer about how Medicare was experimenting with allowing people to have palliative and curative care at the same time. This is known as concurrent care and, while perhaps less sexy than hospice fraud and abuse, may turn out to have greater ramifications should it be adopted widely by Medicare.
Finally, in June 2011, those whistleblower lawsuits became the spine of the story that we wrote for The New York Times. As a news hook, we incorporated some payment changes the Affordable Care Act made to hospices, although in the end I think the rising costs to Medicare and the counterintuitive idea of large publicly traded companies running hospices were enough to be of interest — especially since the stories by Babcock and Ornstein were more than a decade old.
Indeed, we weren’t the only ones sniffing around the issue: a few weeks after our story ran, Bloomberg News’ Peter Waldman published a long investigative piece on for-profit hospices. KHN has done a number of follow-up pieces (see here, here, here and here.) They invariably get a lot of attention and pickup in other media, affirming my belief that people are very interested in stories about hospice and end of life care. In October 2013, Medicare is supposed to start publishing rudimentary quality measures, and that may offer additional opportunities for reporters to study hospice care.
Jordan Rau is a correspondent at Kaiser Health News, an editorially independent news service that is a program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.
