The number of licensed hospice providers in Southern Nevada jumped by more than 350 percent since 2020 — a proliferation combined with minimal industry regulation that health care experts warn harms patients and leads to fraud.

To address the issue, Assm. Rebecca Edgeworth (R-Las Vegas) is sponsoring AB161, which is scheduled for a hearing Wednesday. The measure, Edgeworth said, is a way to “raise the bar” for hospice providers and protect patients.

“In the last few years, there has been this horrendous influx of charlatans and flimflam artists,” Edgeworth told The Nevada Independent.

Hospice care, which typically takes place at home, is designed to help people with terminal illnesses transition through the end of life process. Though Edgeworth said it’s a crucial need for families, there is often little awareness about the proper protocols surrounding care for those with elderly relatives or loved ones who are dying.

The measure arrives following a white paper highlighting the exponential rise of hospice provider licenses in Nevada and advocacy from the Nathan Adelson Hospice nonprofit. Founded in Las Vegas in 1978, the nonprofit has served nearly 85,000 people and has an interdisciplinary team that works on a care plan with patients and families.

The white paper detailed the stories of hospice patients transferred to Nathan Adelson who were not receiving necessary care. 

A hospice nurse told one patient to call 911 when she was suffering from shortness of breath because the nurse was caring for 200 patients and couldn’t help, another transferred because they had not received a care visit in more than four weeks (which is against Medicare rules) and another had severe open wounds that had not been treated. 

“We have countless examples of patients receiving substandard care and operators not adhering to the [federal standards] for hospice,” the paper noted. “[Centers for Medicare & Medicaid Services] makes it very clear that patients have a right to choose the hospice they want for their care.”

Edgeworth’s measure — which she described as essentially a hospice patient’s bill of rights — would add requirements to existing law that hospice care providers:

• Must accept payment through Medicare
• Notify patients when they bill Medicare or another entity
• Be accredited by a national agency
• Cannot accept new patients if any person who holds at least a 5 percent ownership interest in the program is under investigation for or has been found guilty of violating federal, state or local laws surrounding health care payments
• Cannot transfer Medicare billing privileges within 60 months of being authorized to accept Medicare or a 50 percent change in ownership, and
• Undergo enhanced oversight for the first two years after an initial licensure.

Edgeworth said the enhanced oversight will likely lead to a fiscal note and that portion of the bill could change.

Higher standards

The rise of hospice providers in Southern Nevada, detailed in the white paper, has coincided with the crackdown on fraud and abuse cases in hospice centers in California.

In 2021, following a Los Angeles Times investigation that revealed widespread fraud and abuse within the hospice industry, California lawmakers passed a moratorium on new hospice centers while the state conducted an extensive audit of its licensing and oversight processes. 

In June, the Department of Justice arrested five hospice operators in Los Angeles for money laundering and fraud, with documentation indicating that one of the individuals has ties to Nevada. Edgeworth said she’s hoping to prevent that from happening in Nevada.

“If you're going to try to perpetrate fraud on somebody, definitely pick somebody who's going to be dead, right?,” Edgeworth said. “Because [families are] too brokenhearted to complain, they won't even know that they're supposed to complain or how to complain. So, I'm hoping I can fix this a little bit.”

Edgeworth said some new hospice providers in Southern Nevada are avoiding reporting requirements by intentionally capping business at 49 patients, one below the threshold for reporting quality scores to the federal government (though some financial penalties can apply), and then starting a separate company with the same address to accommodate more clients. In one instance, records show 13 hospice operators registered to one office building.

Hospice service is a Medicare benefit and is usually designed for six months of care, though that term can be longer or shorter. 

Karen Rubel, the president and CEO of Nathan Adelson Hospice and one of the backers of Edgeworth’s legislation, said the trouble with the current regulatory system for hospice providers is that it’s complaint driven and many people don’t want to go through a formal process when a loved one is dying. 

She added that she’d like to see a pause or moratorium on licensing to address the issue, but at a minimum, there needs to be more guardrails and oversight surrounding hospice centers in Nevada.  

“We have a moral obligation to make sure that our most vulnerable citizens, those that are dying, have the opportunity to make the right choices for them,” Rubel said.

Edgeworth said she didn’t necessarily agree with a full moratorium, citing a desire to avoid harming legitimate new businesses or eliminating opportunities for hospice centers in rural communities.

“What I’m trying to do is hold people to a higher standard,” she said.