In an alarming turn of events, some unethical hospice providers are increasingly turning their attention to a new target to boost their patient census—and by extension, their revenue. This new focus is on opioid treatment programs (OTPs), otherwise known as methadone clinics, and the vulnerable patients they serve. Reports from the hospice industry suggest that bad actors, particularly in California, are exploiting homeless individuals and those receiving opioid use disorder (OUD) treatment to enroll them in hospice care under false pretenses.
These hospice providers, looking to increase their patient count and revenue, are offering patients, many of whom are already struggling with addiction, free housing, daily morphine doses, and even cash in exchange for enrolling in hospice programs. As highlighted in an Aug. 23 report from Hospice News, this dangerous practice not only exploits the patients’ vulnerabilities but also raises serious concerns about hospice fraud, abuse, and ethical breaches in the healthcare system.
The Exploitative Practices of “Bad Actors”
Hospice care is meant to provide compassionate end-of-life care to those with terminal illnesses, yet an increasing number of hospice providers are now exploiting the system to pad their bottom lines. These “bad actors” are targeting individuals who are not terminally ill at all, offering them a steady supply of powerful opioids like morphine in exchange for enrolling in hospice care. The motivations behind these actions seem to be driven by financial gain: increasing the number of patients, thereby inflating the hospice’s revenue.
These predatory practices typically target two vulnerable groups: homeless people and individuals who have been receiving treatment at methadone clinics for opioid use disorder (OUD). Many of these individuals, desperate for housing and basic needs support, are promised daily doses of morphine, a roof over their heads in board-and-care facilities, and even cash incentives—all in exchange for agreeing to enroll in hospice care. In many cases, these individuals are not terminally ill but are instead struggling with addiction or simply in need of a safe place to live.
Once enrolled, these patients are kept on high doses of opioids—specifically morphine, a powerful painkiller—under the guise of hospice care. The patients’ addiction is further exacerbated by continuous access to narcotics, leading to a dangerous cycle of dependency and health deterioration. The effects of opioid misuse are devastating, and these individuals are being further exploited by a system that is supposed to provide them with compassionate end-of-life care.
As highlighted by Hospice News, these patients often have little to no idea of the dangers they are facing, as many are ill-informed about what hospice care actually entails. Instead of receiving the palliative care they need for end-of-life conditions, they are being used as pawns in a scheme that benefits unethical providers. It is a clear violation of the core principles of hospice care, which is supposed to focus on enhancing quality of life for the terminally ill, not exploiting vulnerable individuals for financial gain.
The Dangerous Impact on Vulnerable Patients
The impact of these predatory practices on patients is deeply troubling. Many of the individuals targeted by these unethical hospice providers have already been receiving medication-assisted treatment (MAT) at methadone clinics for opioid use disorder (OUD). This treatment is critical for helping individuals recover from addiction and avoid relapse. However, the hospice providers in question are offering them opioids like morphine, which directly undermines their recovery efforts.
Giving individuals who are in recovery from opioid addiction access to morphine creates a host of dangerous risks. For one, it can reignite their addiction, setting them back in their recovery journey and increasing the likelihood of overdose. Methadone treatment is already carefully regulated, but introducing high doses of opioids like morphine introduces a level of unpredictability that can be deadly. In some cases, patients may not even be aware of the dangers they are facing, as they are misled by the promises of free housing, medical care, and a “better life.”
Moreover, the individuals who are most often targeted in these schemes—those in methadone clinics and the homeless—are often the most vulnerable members of society. They may not have the resources or support to make informed decisions about their care, and they may feel pressured into enrolling in hospice care simply to meet their basic needs. By offering them opioids and other incentives, these hospice providers are taking advantage of their desperation and creating a dangerous situation for those who are already in a fragile state of health.
As one hospice executive explained, these bad actors are essentially running a business model that thrives on the exploitation of vulnerable people. They recruit homeless patients from methadone clinics, promising them a safe living environment and a constant supply of morphine, which further fuels their addiction. The executive expressed concern that deaths resulting from overdose might be misclassified as deaths due to terminal illness, allowing these providers to continue receiving payments for patients who were never truly terminally ill in the first place. This type of practice is a textbook example of hospice fraud.
Hospice Industry’s Ongoing Struggles with Fraud and Abuse
The hospice industry has been under increasing scrutiny over the past few years, with widespread reports of fraud, waste, and abuse plaguing the system. The predatory practices targeting opioid treatment patients are just one example of a larger issue within the hospice care sector. New reports have revealed unethical practices that include targeting homeless individuals and others who do not meet the clinical criteria for hospice care.
In 2021, a report by California’s Department of Justice highlighted the state’s history of lax oversight in the hospice industry. This lack of oversight, combined with a rapid increase in the number of newly licensed hospices, particularly in states like California, Texas, Nevada, and Arizona, has created a fertile ground for unethical practices to flourish. Hospice News has reported extensively on these issues, documenting how some newly established hospice providers are engaging in fraudulent and exploitative behavior to maximize profits.
Despite efforts by federal regulators and some state governments to address these issues—such as halting the certification of new hospice providers in certain high-risk markets—these efforts have not had the desired effect. The problem remains persistent, with new bad actors continually emerging to exploit the system. A 2024 Hospice News report suggests that even with heightened regulatory scrutiny, the practice of targeting vulnerable individuals for fraudulent hospice care continues unabated. The perpetuation of hospice fraud has raised alarms across the healthcare industry.
The issue gained national attention in 2024 when the HBO satirical news program Last Week Tonight with John Oliver aired an in-depth segment on the crisis within the hospice industry. The segment helped bring the issue to the forefront of public consciousness, highlighting the urgency of reform in a system that is meant to provide compassionate care for those nearing the end of life.
Calls for Accountability and Reform
The continuing exploitation of opioid treatment patients by unethical hospice providers has sparked widespread condemnation within the hospice industry. Industry leaders, including Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), have called for stronger oversight, accountability, and legal consequences to prevent these predatory practices from continuing. Dombi described the conduct as not only fraudulent but also “predatory,” taking advantage of individuals who are already struggling with addiction and homelessness.
In the words of one executive who spoke with Hospice News, the behavior of these providers is akin to a “pyramid scheme.” The providers are constantly searching for more patients, prioritizing financial gain over patient care. This harmful dynamic is contributing to a crisis of trust within the hospice care sector, which has long been seen as a compassionate and patient-centered field.
To protect vulnerable populations and restore faith in the hospice industry, significant reforms are needed. These should include stricter regulations, enhanced oversight, and more robust enforcement of existing laws to ensure that hospice providers are held accountable for unethical practices. Furthermore, better education and awareness programs for patients and their families could help prevent individuals from being exploited by bad actors in the future. Without such reforms, the industry will continue to be plagued by hospice fraud and other harmful practices.
Conclusion: A Call for Immediate Action
The rise of predatory practices within the hospice care sector—particularly the targeting of patients from opioid treatment programs—has revealed deep flaws in the system that must be addressed immediately. Hospice care should be a compassionate and ethical service for those at the end of life, not a revenue-generating enterprise that exploits vulnerable individuals.
The patients most at risk from these unethical practices are those who are already struggling with addiction, homelessness, and poverty. They are the ones being lured into false promises of free housing and constant access to opioids, only to be subjected to a dangerous cycle of addiction and exploitation. The time for reform is now. If the hospice industry is to regain the public’s trust and serve those in need with dignity and respect, it must confront these unethical practices head-on and ensure that accountability and compassion are prioritized over profit. Only by addressing hospice fraud can we ensure that vulnerable individuals receive the care and respect they deserve in their most difficult times.
