Hospice Owner Fights Rising Medicare Debts

Unfunded Congressional Mandate Sticks Hospice Owner Bobbie Fleming With $3 Million Bill

(CBS)  Registered nurse Bobbie Flemming drives about 1,000 miles a week around the Mississippi Delta, making dozens of house calls.

But Fleming, a hospice owner, is not out to save lives. Her goal is to help her terminally ill patients die in peace, by offering, as she says, "Just a small amount of comfort and compassion on this end-of-life journey."

But there's a problem: 11 years ago, Congress mandated that terminally-ill patients are entitled to unlimited hospice care - but Medicare only pays the hospices for six months' worth, CBS News correspondent Thalia Assuras reports.

So when the federal government realizes its been paying for people like throat cancer patient Willie Ross for well over six months, Medicare demands its money back - plus 12 percent interest.

Flemming's current bills show she owes more than $3 million.

She says whatever funds she has go to purchasing drugs, buying medical equipment and paying staff salaries. And she has no intention of denying her patients treatment.

"I'm not the one to say because you're not dead, I'm just going to dump you," said Flemming. "It's not in me to say that."

Medicare declined to comment to CBS News, citing a lawsuit on the issue. But it has offered Flemming a choice - either pay up or declare bankruptcy.

"I've always done the right thing about end-of-life care," said Flemming. "I'm going to continue to do it and someone is going to eventually hear this."

Flemming recently took her case to Capitol Hill with other hospice owners, asking Congress to freeze their debts until it can come up with a way to pay for extended hospice care.

Until then, Flemming said she's not going to play God by turning away patients just because they don't die on schedule.

[grammawhamma]

I "used" to work for a Catholic run hospice program. The way they got around this was to start upping the morphine doses before the six months were up. The patients that were allowed to linger longer were those who had substantial wealth and paid their own way.

[bcanipe]

This is just like all other goverment programs, people will try to "work" the system and this only hurts the people that need the help. Remember a rotten apple spoils the whole basket.

[unicorn261]

I think having worked for Mrs.Flemming, Hospice is a wonderful thing for the terminally ill patients who truely need it, but if her patients are carefully evaluated you will see that many of them don''t qualify for hospice. They will let you know that they are there for a free ride. They will tell you that there''s nothing wrong with them they are just on it for the free medication. Now you tell me, is that really hospice appropriate?

[dbrazeal2]

dbrazeal2 Continued:

Shame on the hospices who aren''t standing up for the rights of those who continue to be eligible for their hospice benefit, yet haven''t died within an acceptable financial timeframe. We should ALL be standing together in this horribly financially devestating time for any single hospice over cap, much less the numbers reported from 2005. Our common sense should tell us that statistics from 2005, are only bound to foretell of future cap problems for many more. So...if you are not discharging eligible patients, and you are billing for every patient you have on service...tell the truth...how long before you have a cap problem?
Let''s all support the PATH bill and let our legislators know that we are united in focusing our efforts on the quality of care for those we serve, and want to stop, thru the Moratorium (PATH) the quarrelling and arguing, which is distracting us as an industry.

[dbrazeal2]

I own and operate a hospice in Tulsa, OK. I appreciate CBS''s coverage of this very important and daunting situation. It is important, to at the very least inform the public regarding this "cloud" over the end of life benefit which we have all paid for and should expect to be available when we reach the point of medical eligibility...without worrying about "out living" our benefit.
The Senators and Congressmen who sponsored the PATH Bill are to be commended for taking the time and making the effort to understand the end of life needs of their constiuents. Too many time our legislators "land their jobs" and then forget who they represent.
(Continued)

[gcmc1]

Great show on Hospice! My mother is on Hospice and this story really needs to be told so that Hospice Care in rural areas can survive.

[capt_rich]

Having worked for Mrs. Flemming, I think if they carefully evaluated her current and past patients for meeting the guidelines for hospice, it would become clear why she is having a problem with Medicare Cap.

[rememberme51]

Having been a Hospice Nurse for 11 years now, I fully understand the "cost" of the cap which weighs heavily on us all. I am blessed to now work for a company who does the right thing despite the monitary cost. It is unfortunate that many of our patients who are truly appropriate and who meet qualifications to receive Hospice Care have come "discharged" from other Hospices who have kept them as patients long enough to cover cap costs, but then have "dumped" them with few options after they failed to die in 6 months or less. The "cost" of caps is measured in much more than dollars. How demeaning and undignified it is to cause undue worry on families who are already suffering tremendously! I pray that when the time comes for me to need Hospice Services I wont have to worry whether or not I will be cared for after my alloted 6 months are up! The alternative of dying in the hospital at twice the cost to the government in an unfamiliar setting without all of the people I care about around me is less than appealing.

[serenity394]

We at Serenity Hospice are in agreement with other Hospice Agencies as related to PATH ACT and feels no one should be denied care or hospices denied payment because of a flawed law many years ago that didn,t get revisited.Patients are entitled to end of life care regardless of length of time to one''s eternity which can only truthfully be decided by one and his name is jesus.

[serenity394]

We at Serenity Hospice are in agreement with other Hospice Agencies as related to PATH ACT and feels no one should be denied care or hospices denied payment because of a flawed law many years ago that didn,t get revisited.Patients are entitled to end of life care regardless of length of time to one''s eternity which can only truthfully be decided by one and his name is jesus.