2025-08-18

Medicare Fraud of the Month: Palliative Care Scams Target Seniors

Albany, New York – August 18, 2025 – The New York Statewide Senior Action Council (Statewide), a non-profit association dedicated to the well-being of the approximately 2.5 million older adults in New York State, today announced August’s “Medicare Fraud of the Month”: Medicare fraud in palliative care.

This “Fraud of the Month” component is part of the medicare Patrol for Older People (SMP), a resource for seniors and caregivers in New York to detect, prevent, and report healthcare fraud, errors, and abuse. Statewide serves as the designated administrator of this federal program.

Palliative care is a complete program focused on providing comfort and improving the quality of life for individuals wiht serious illnesses, rather than seeking a cure. services frequently enough include medical care, respite care, medication, and durable medical equipment for pain management.

Maria Alvarez, Executive Director of Statewide, urges seniors to be cautious of potential schemes related to palliative care. “Scammers are targeting older adults with offers of free services like kitchen or cleaning help, assistance, or home equipment, and even false home health visits.”

“But behind these offers, they are enrolling seniors in palliative care programs without their knowledge and billing Medicare for services that were not needed or received,” she added.

Scammers are reaching potential victims through:

Puerto Rican Views
Unsolicited phone calls
Text messages and emails
false advertising

Alvarez advises seniors to be aware of warning signs and protect themselves:

Remember: Only a doctor can certify a patient for palliative care (generally with a life expectancy of six months or less). Medicare never covers free services such as cleaning services.
Never accept gifts in exchange for medical services.
Always check your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) to verify there are no charges for unauthorized services.The Medicare Patrol for Older People in New York state can assist seniors with questions, concerns, or complaints about nursing home fraud, abuse, and quality of care issues. Certified counselors are available to provide help. Call 800-333-4374.

“We have trained counselors who help inform Medicare beneficiaries in the fight against healthcare fraud,” Alvarez concluded. “To report medicare fraud,errors,or abuse,you can call our Medicare Fraud Help Line at 800-333-4374 or visit www.nyseniors.org.”

Statewide also provides details and educational presentations regarding Medicare and helps with understanding plan options, appealing decisions, and patient rights throughout New York.It’s estimated that Medicare fraud costs taxpayers $60 billion annually. This initiative aims to combat these illicit activities and protect the state’s senior population.

What steps can palliative care providers take to ensure accurate billing practices and minimize the risk of inadvertently contributing to Medicare fraud?

New York’s Medicare Fraud Spotlight: Palliative Care Becomes August’s unregulated Healthcare Sector Concern

The Rising Tide of Medicare Fraud in Palliative Care

New York State is currently experiencing a surge in Medicare fraud investigations, with a significant focus now directed towards the palliative care sector.August 2025 marks a critical point,as authorities identify a concerning lack of oversight and increasing instances of fraudulent billing practices within this rapidly growing area of healthcare. This isn’t simply about inflated claims; it’s a systemic issue impacting patient care and draining vital Medicare resources. Understanding the nuances of this fraud is crucial for patients, providers, and anyone involved in the healthcare system.

Why Palliative Care? A Vulnerable Sector

Several factors contribute to the vulnerability of palliative care to fraud.

Complex Billing Codes: Palliative care frequently enough involves a combination of medical, psychological, and social support, leading to intricate billing codes that are easily manipulated.

Limited Regulatory Scrutiny: Compared to other healthcare specialties, palliative care has historically faced less stringent regulatory oversight.

Increased Demand: The aging population and growing awareness of palliative care benefits have led to a surge in demand, creating opportunities for unscrupulous providers.

Home-Based services: A significant portion of palliative care is delivered in patients’ homes, making it harder to monitor and verify services rendered. This increases the risk of home healthcare fraud.

common Medicare Fraud Schemes in Palliative Care

Investigators are uncovering a range of fraudulent activities. Here are some of the most prevalent:

1. Billing for Services Not Rendered: This includes claiming payment for visits that never occurred or for services that were not medically necessary.
2. Upcoding: providers are intentionally submitting claims using codes for more expensive services then those actually provided. Such as, billing for a complete assessment when only a brief check-in took place.
3. Unbundling: Breaking down a single, comprehensive service into multiple, separately billed components to maximize reimbursement.
4. Kickbacks and Illegal Referrals: Providers receiving payments for referring patients to specific palliative care services or suppliers. This violates the Anti-Kickback Statute.
5. Phantom Employees: Billing for services allegedly provided by non-existent staff members.
6. Duplicate Billing: Submitting multiple claims for the same service.

The Role of the Medicare Fraud Strike Force

the Medicare Fraud Strike Force,a joint initiative between the Department of Justice and the Department of Health and Human Services (HHS),is actively investigating these cases in New York.Recent actions include:

Increased Audits: Targeted audits of palliative care providers across the state.

Criminal Charges: Filing criminal charges against individuals and companies involved in fraudulent schemes.

Asset Seizure: Seizing assets obtained through fraudulent activities.

Provider Sanctions: Imposing sanctions, including revocation of Medicare billing privileges, on fraudulent providers.

Impact on Patients and the Healthcare System

Medicare fraud in palliative care has far-reaching consequences:

Compromised Patient care: Fraudulent practices can divert resources away from legitimate care, possibly harming patients.

Increased Healthcare Costs: Fraudulent claims drive up healthcare costs for everyone.

Erosion of Trust: Fraud undermines public trust in the healthcare system.

Strain on Medicare Resources: Fraudulent payments deplete the Medicare Trust Fund, jeopardizing the program’s long-term sustainability.

Protecting Yourself: A patient’s Guide

If you or a loved one receives palliative care in New York, here are steps you can take to protect against fraud:

Review Your Medicare Summary Notices (MSNs): Carefully examine your MSNs for any services you didn’t receive or that seem unusual.

Ask Questions: Don’t hesitate to ask your palliative care provider about the services they are billing for.

report Suspicious activity: If you suspect fraud, report it to the Senior Medicare Patrol (SMP) or the HHS Office of Inspector General (OIG).

Understand Your Rights: Familiarize yourself with your rights as a Medicare beneficiary.

Resources for Reporting Medicare Fraud

Senior Medicare Patrol (SMP): 1-800-998-6661 or https://www.smpresource.org/

HHS Office of Inspector General (OIG): 1-800-HHS-TIPS (1-800-447-8477) or https://oig.hhs.gov/

Medicare Fraud Hotline: 1-800-MEDICARE (1-800-633-4227)

Increased Licensing Requirements: Implementing stricter licensing requirements for palliative care providers.

Enhanced Billing Audits: Conducting more frequent and thorough billing audits.

Improved data Analytics: Utilizing data analytics to identify patterns of fraudulent activity.

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