Last Week Tonight With John Oliver (2014) s11e21 Episode Script
Hospice
Welcome to "Last Week Tonight"!
I'm John Oliver.
Thank you so much for joining us.
It has been a busy week.
Ukraine continued to push
into Russian territory,
the internet tried to figure out
what happened behind the scenes
on this movie,
and the Trump campaign continued
trying to counter enthusiasm
for the Democrats' new ticket
with JD Vance,
a man who perpetually looks like
he got stuck 10% of the way
to transforming into a werewolf,
desperately trying to spin the joy
of Harris' recent rallies as a negative.
She says she's having fun.
Well, while she's having fun,
Americans are suffering
under her policies.
When she laughs during a speech,
remember that there are American
families crying this very day
because they cannot afford
groceries.
When she does these rallies
and does these events
and does these fake dances,
remember that there are parents who
lost their children to drugs or violence
who will never see their children
move again, much less dance again.
What are you doing? Scolding people
for enjoying stuff
because there are sadder things
happening elsewhere
is a shitty thing to do, although
it does make me curious
what Vance is like
in other social situations.
"All right kids, enjoy SeaWorld, meet us
back here at 2:00 and remember
dolphins will sometimes kill porpoises
for sport! Have fun!
Scientists call it porpicide,
by the way!"
Also, for what it's worth, bumming
everyone out with depressing facts
about things you like isn't how
you become vice president,
it's how you put people
to sleep once a week
while aging like a wartime president.
Get the fuck off my corner!
The Trump-Vance campaign
has also been trying to deflect charges
of Republicans being weird.
Just last week Trump told a rally,
"I think we're the opposite of weird,
they're weird".
And told a radio host,
"Nobody's ever called me weird.
I'm a lot of things,
but weird I'm not."
So, you know it's getting to him. But
also, nobody's ever called you weird?
Babe, be serious.
You tried to buy Greenland,
you stared at the sun during
a solar eclipse, and you did this.
That's not something
a normal guy does.
I don't know what a normal guy
would do, because I'm also not one,
but I know it's not that.
The "weird" label has been
particularly hard to shake,
because Republican candidates further
down the ballot keep compounding it,
including some who won primaries
just this week,
like Royce White.
He became Minnesota's Republican
Senate candidate, and he is a lot.
He's a former NBA player,
far-right podcaster,
and a die-hard Trump supporter,
as he will tell you.
Donald Trump could get up on stage,
pull his pants down,
take a shit up at the podium,
and I still would never vote
for you fucking Democrats again.
Let that sink in.
Okay, okay, I'm letting it sink in.
All right, it's sunk in now,
and I do still have some questions.
Is there a place where Trump
could take a shit
that would make you vote
for Democrats again?
Like on a merry-go-round,
would that make you vote for them?
Or if he shit inside a gumball machine,
would you vote for Democrats then?
Or if he went into your bathroom,
put the toilet lid down,
and shit on the toilet instead of in it,
would you at least consider voting
for an independent who caucuses
with the Democrats?
You know what? Let that sink in
and just get back to me.
White's been endorsed
by Steve Bannon and Alex Jones,
whom he once supported by writing
this message on the side of his head.
He's also said, among other things,
that he's not sure if a plane hit
the Pentagon on 9/11,
claiming there's no footage of it,
which, of course, there very much is,
and he even once tweeted out this map
he claimed showed "crime in
Minneapolis" is out of control",
which turned out to be a map
of the city's drinking fountains.
Which is embarrassing. There are so
many real crime maps he could've used,
like this one, except, I'm kidding,
that's New York's rat information
portal, you idiot!
You just got schooled by the rat map!
Rat map!
But White is just one of a number
of odd GOP Senate candidates.
In Virginia, there's Hung Cao,
a retired Navy captain
with no political experience,
who's also a very strange man.
We can't let it turn like this.
There's a place in Monterey,
California called Lovers Point.
The original name
was "Lovers of Christ Point",
but they took out the Christ,
it's Lovers Point.
Monterey's a very dark place now.
A lot of witchcraft. The Wiccan
community has really taken over there.
And we can't let that happen
in Virginia.
If Monterey is actually overrun
by witches, which it's not,
I'm frankly furious there wasn't
a witchcraft storyline
on Big Little Lies.
How could you deprive us of Nicole
Kidman showing up to a moonlit orgy
and announcing,
"We come to this place for magic"?
Everyone's head would've exploded.
And while Cao and White
are unlikely to win,
other Republican candidates
like Eric Hovde,
Ned Flanders without
the raw sexual charisma,
do have a real shot.
This week, he won Wisconsin's
Senate primary in a landslide.
He's the wealthy CEO
of a bank called Sunwest,
so he's self-financing his campaign.
And he's taken some flak not just for
owning a property in California,
but spending a significant
amount of time there,
something he tried to deflect
with this video.
It's good to get out here
for a good cold plunge.
So, the Dems and Senator Baldwin
keep saying I'm not from Wisconsin.
Which is a complete joke.
All right, Senator Baldwin, why don't
you get here in this frozen lake
and let's really see
who's from Wisconsin?
I hope everyone has a great day.
Take care.
Well, now I'm having a terrible day,
'cause I did not want to see that.
Why physically torture yourself
to prove you're from Wisconsin,
when your incredibly strong accent
does that on its own?
Also, challenging someone
to meet you in a frozen lake
to score political points is pathetic.
I'd say it was a dick-measuring contest,
but I'm guessing, given the temperature
of that water,
yours has disappeared
into your body right now.
Hovde's views are what you'd expect
from a Republican candidate,
from supporting repealing
the Affordable Care Act,
to blaming immigrants for
"all the crime that has unfolded".
But he can also be pretty awkward
with voters,
like when he showed up
at a Juneteenth celebration,
and a radio host tried to feed him
softball questions.
And I'm gonna warn you, this is
extremely uncomfortable to watch.
What is a few of your takeaways
from being down here
at the Juneteenth parade here?
It's a hell of a good party,
and I'm really enjoying it, man.
All these little entrepreneurs
selling their wares,
really friendly people,
great food.
Is there anything you're going
to take away from this
that you didn't know about Black
culture before?
Look, I've spent a lot of time
in Black culture, and as Torey knows,
I've spent a lot of time in places
like Africa
because I have homeless shelters
for abandoned kids
and rescuing kids out of the streets.
And I've been involved in schooling,
charter schools and things
of that nature.
Stop talking, Eric! Stop talking!
You're hurting me to hear that!
There are so many easy answers
to the question
"What have you learned
about Black culture today?"
and among the worst is definitely,
"Not much, because I've already been
to Africa."
Fun fact: Black American culture
isn't actually synonymous
with African culture.
If you want to know why,
just Google "Juneteenth"
or ask one of the, quote,
"little entrepreneurs" you just met.
They'll fill you in.
I get Republicans want to get out from
under accusations of weirdness.
But the way to do that is to stop
being so fucking weird.
Because fantasizing about your party's
candidate shitting in front of you?
That's weird.
Warning everyone about the influence
of Monterey witches? Weird!
Inviting your female opponent
to join you in a frozen lake?
That is very weird!
And I do apologize for laughing
at these people,
partly because I know it's not nice.
But mainly because,
as we all now know,
JD Vance believes every time
someone laughs,
somewhere in the world, a child loses
their groceries for some reason.
And now, this.
And Now: Newscasters Come to Terms
with Life After the Olympics.
And just like that, the Olympics
are almost over.
What am I going to do with all my time
now that the Olympics are over?
- Probably go back to Taylor Swift.
- I guess I'll have to.
- Now you got nothing to watch.
- I don't know what I'm do.
And it's just one of those things
that kind of unites everybody.
You know, temporarily. Now we can go
back to hating each other.
I'm kind of sad the Olympics are over.
It was so much fun.
There were some personal benefits
to the Olympics,
like we didn't have a 30-minute news
program for two straight weeks.
- I miss the Olympics.
- Do you?
- Yeah, I do.
- They'll be back in four years, Ron.
- In LA.
- Hopefully, I'll be back in four years.
I am so glad the Olympics are over
because I'm tired of crying.
Watching the Team USA on the track.
Especially the women's teams, just
smashing gold after gold after gold.
I'm tired. They're tired.
They're a little more tired than I am,
but, you know.
All right, 4:05 this morning, crews have
removed the massive whale carcass
that washed up ashore
in Torrance Beach.
Moving on. Our main story tonight
concerns death.
The answer to the question,
"What does the interior
of an IHOP smell like?"
Lots of us have questions
about death. And luckily,
this nurse on TikTok can answer
at least one of them.
Hey, good news to all you sinners
out there,
I have never seen anyone dying start
seeing signs
that they are going to hell,
demons, fire, anything like that.
So, I think we're good.
Are you sure about that, though?
Because maybe patients
aren't telling you what they see.
I get why someone wouldn't want
their last words to be,
"Oh no, there's fire, there's Hitler,
Jeffrey Epstein,
Is that my childhood dog, Rusty?
What're you doing here?
And why does Charles Manson look
like he respects you?
What did you do, Rusty? Bad boy!"
That nurse actually works for the type
of medical business
we'll be focusing on tonight: hospice.
I realize that doing an episode about
hospice is an almost offensive parody
of this show, if somebody else did
that, it would genuinely be hurtful.
But I promise,
this is worth talking about.
And you're probably at least somewhat
familiar with the concept of hospice,
it's end-of-life care that helps
terminally ill people die comfortably.
You may even have seen ads
for hospice on TV.
And if you live
in southeast Connecticut,
you might have seen this
weirdly horny one.
If there was one thing I could do over,
I would have reached out sooner
to Center for Hospice Care
for my husband.
When Center for Hospice Care
came into our life,
it allowed me to be with him.
To really be with him, without having
to coordinate all his care.
Their nurses, social workers,
and other caregivers gave me
the freedom to be his wife again.
To love him like a wife.
That is, and I say this
with absolute certainty,
the single horniest hospice ad
I've ever seen,
from the fervid hand-humping
to this absolute masterclass
in eye-fucking, to the erotic
vegetable-themed foreplay.
That looks less like a hospice ad
and more like a VHS tape called
"Tantric Sex for Couples Over 50".
Hospice is designed for those
with terminal illness who choose
not to get treatment
to cure or control it,
and it's meant to provide support
for the person and their family,
including relief of symptoms and pain.
And that support can take many forms,
even allowing for moments like this.
A hospice patient got a special visitor.
Peggy Garrison loves flamingos.
She pays homage
to the majestic animals
with the 158 trinkets and decorations
she's collected throughout her life.
Now that the 75-year-old
is in the final stages of cancer,
a flamingo named Mango paid her
a visit from the San Antonio Zoo.
The San Antonio Zoo said it was happy
to allow Mango to meet Peggy
to honor the life she spent
loving these animals.
That is great! I love that
that happened for Peggy!
Although, do spare a quick thought
for Mango the flamingo there.
Imagine you went to the home
of someone that you didn't know
and they had 158 images
of you everywhere.
You'd definitely think you were
about to get murdered.
That woman and her family
had a positive experience
with their hospice provider.
And the good news is,
many, many people do.
Lots of dedicated people work
with hospices,
providing huge relief for dying
patients and their families,
particularly those who want to remain
at home, where, in most cases,
hospice care is provided.
About 1.8 million Medicare beneficiaries
now receive hospice care each year.
In fact, you'll probably encounter
hospice at some point in your life,
either for yourself, or for a loved one.
And at its best, it is great.
Unfortunately, at its worst, it is not,
as the hospice industry has become
riddled with stories like these.
A local company agrees
to a $75 million settlement
over alleged overbilling
of hospice services.
A Cleveland doctor has been
sentenced to five years in prison
for healthcare fraud connected
to hospice operations
in the state's impoverished
delta region.
California's attorney general
is announcing the arrest
of over a dozen people accused
of running a hospice scam
in the Inland Empire.
It's true.
There is a lot of hospice fraud.
A sentence, by the way, recently
voted "least hot"
by Things to Whisper Into Your
Partner's Ear During Sex Magazine.
But it is true,
there's a lot of hospice fraud.
In fact, one government report
estimated
that hospices' inappropriate billing
costs Medicare
hundreds of millions of dollars a year,
and experts say they believe
that figure to be far higher.
And the financial consequences
here are the least of the problems.
So, given that, tonight,
let's look at hospice care,
how it's supposed to work, and what,
too often, is happening instead.
And let's start with the fact that
hospice, as we know it, is pretty new.
Here's a TV report from 1979,
explaining it to Americans
as if for the first time.
A new concept for taking care of
terminally ill patients
is gaining interest in this country.
It is called hospice and comes to us
by way of England.
The philosophy behind hospice is that
once death has become inevitable,
patients should be treated with
great attention to their comfort
and emotional needs.
Yeah, hospice actually came
from England!
And I know the British exporting
a new way to die sounds like
the perfect slogan for over 400 years
of colonialism,
but in this case,
it was genuinely a good thing.
The concept was originally conceived
by dame Cicely Saunders,
seen here looking like
she just slashed your tires.
She was an English doctor
and social worker,
who'd been upset by the "wretched
habits of big, busy hospitals
where everyone tiptoes past
the bed and the dying soon learn
to pretend to be asleep."
Which sounds bleak but, remember,
that was in the U.K.,
home of the famous war-time poster:
"Keep quiet and die."
The idea eventually migrated over here
and the first American hospice
began caring for patients in 1974.
More soon followed, mainly consisting
of "a constellation of charities,
mostly reliant on volunteers."
But in 1982,
Reagan made a big change,
when he authorized Medicare
to cover the cost of hospice,
after advocates convinced lawmakers
"it would be cheaper for Medicare than
paying for the aggressive treatment
that so many patients received
up until they died."
That move meant there was now
a lot more money to be made
in the hospice business.
And today, of the country's
roughly 6,000 providers,
three-quarters are for-profit.
One of the biggest and earliest
was Vitas,
which was founded by two teachers
and Don Gaetz,
who is, fun fact, Matt Gaetz's dad.
Which is kind of surprising.
I didn't think Gaetz had parents
in the traditional sense,
I just assumed someone jizzed
on a "Goodfellas" poster.
Vitas made its founders
extremely wealthy.
In 2004, it sold for $406 million
to Chemed,
best known as the owner
of Roto-Rooter, a plumbing company.
In fact, on Glassdoor,
Chemed is described as bringing
"a professional dignity to times
of transition and sewer line clogs."
So, now you know who to call
if you're facing your own mortality
and/or a backed-up shit pipe!
The point is,
hospices can be big business.
And it's worth talking about exactly
how they make money.
Basically, once you're enrolled
in a hospice,
they get a flat fee every day
for routine care.
It's a little over $200 a day
for the first 60 days,
and a little less for however long
you're in hospice after that.
And that can create a clear incentive
to sign up as many patients as possible.
A marketer for one hospice in Georgia
was even recorded telling a sales rep,
"How do you solicit patients?
You see somebody sitting on the front
porch in a wheelchair
and you hit the brakes."
And you know our system is broken
when a hospice provider's target demo
is kidnapped porch grandmas.
One big way hospices can get referrals,
though, is by befriending staffs
at nursing homes
and doctors' offices.
In fact, Vitas has been particularly
aggressive in its sales tactics,
like when they were caught doing this
in the middle of 2020.
Text messages we obtained show
Vitas salespeople visiting
multiple Bay Area nursing homes and
doctors' offices during the pandemic.
They took numerous selfies
with healthcare workers,
some bringing gifts of pizza, chicken,
or doughnuts.
Under one picture,
a rep even wrote,
"Six boxes of these made their way
into a local nursing home
that isn't allowing food
in from the outside."
A fellow employee texted back,
"Sneaky, sneaky."
Another email shows a manager
running a weekend referral contest,
saying "whoever gets the most selfies"
with medical personnel could win.
Personnel including nursing home staff,
emergency room staff,
physicians, or nurses.
It's true. To get patient referrals,
they were sending sales reps
into nursing homes,
and encouraging them to get selfies
with healthcare workers
who were interacting with high-risk
populations, at the height of Covid.
That sounds like a plan literally
hatched by the coronavirus itself.
And incidentally, you know
what's not "sneaky, sneaky"?
Bragging about your unethical sales
tactics in writing,
that is more stupid, stupid.
So, that is just one way
hospices can make money,
getting as many patients as possible.
Another is to then spend as little
on those patients as you can.
Underwhelming care is a persistent
complaint about hospices,
with a recent survey finding over one
in five families said
their hospice agency did not always
provide timely help.
And recent investigations by HHS
have found some alarming examples
of neglect, like a hospice that billed
Medicare for 17 days of care
for a 70-year-old patient
that they never visited.
Instead, they just called his family
to inquire how he was doing.
And it is hard to defend the quality
of that company's service
when they were quite literally
phoning it in.
But it gets worse, because they also
found multiple cases of severe neglect,
like when a hospice skipped home visits
and failed to assess the amount
of pain one patient endured,
with that patient eventually suffering
a maggot infestation in his feeding tube
that required a trip
to the emergency room.
Which is horrifying! Treatment for
dying people ideally should not sound
like a scene from
a fucking "Saw" movie.
And providing subpar care
is bad enough.
But some hospices engage in
outright fraud, to overbill Medicare.
Because if patients require
a higher level of care,
hospices can bill the government
at a much higher rate,
as much as $1,500 a day
for "continuous home care",
sometimes called crisis care.
Vitas was even sued by the DOJ
in 2013
for billing Medicare for more
costly crisis care services
when certain patients
did not need them.
Over eight years, the government
says that Vitas generated
nearly a billion dollars in revenue
from crisis care,
and while the company didn't
admit wrongdoing,
it did pay $75 million
to settle that case.
The kind of thing that we all do when
we haven't done anything wrong.
And Vitas is by no means the only
company accused of doing this.
Passages Hospice used to be the
biggest hospice company in Illinois,
until this happened.
Passages Hospice in Moline forced out
of business today
after the indictment of one
of its owners on federal fraud charges.
Lawyer Seth Gillman of Lincolnwood
was charged by the feds last month
for allegedly overcharging Medicare
and Medicaid.
The company and its 300
workers statewide, history.
Gillman faces up to 15 years
if convicted.
I would describe him as
the lowest form of life.
He deserves what's coming to him.
You know how wretched
you have to be
for a middle-aged midwestern woman
to call you "the lowest form of life"?
She didn't even dress it up with
a "he's not my cup of tea"
or "I think he has a lot to answer for."
That is midwestern
for, "I hope he dies in pain,
and I'll personally block traffic
to ensure an empty funeral home."
Gillman was eventually sentenced to
six and a half years in federal prison
for masterminding
a $20 million fraud scheme
that included enrolling patients
in expensive in-patient care
they didn't need.
Families told reporters that Passages
employees even misled them
into believing their loved one
had serious or terminal illnesses,
when they didn't.
A federal court found Gillman
pocketed millions annually,
and enjoyed a lavish lifestyle
that included corporate airplanes,
and luxury sports cars,
behavior his own lawyer
in a court filing,
partly attributed to the fact he was
ingesting cocaine on a daily basis.
That was his defense!
Imagine how guilty you have to be
for your own lawyer to say,
"Your Honor, my client may
as well be Shaun White
the way he was shredding down
mountains of pure white powder,
I'm talking in his defense,
you understand."
But it's not just exaggerating
the amounts of care
that patients are getting,
hospices can also enroll patients
who shouldn't even be there
in the first place.
Because while there's a requirement
that patients have a life expectancy
of six months or less,
most of the Medicare spending
on hospice is now for patients
whose stays exceed six months.
And look, obviously, it is a good
thing when someone lives longer
than their prognosis.
This show is not pro-death.
To be honest, sometimes we are.
But most of the time, we are not.
But there are worrying signs some
hospices are enrolling patients
who don't need their care.
And one indicator of this is
the "live discharge rate",
basically, how many people leave
hospice alive.
Now, a small amount of live
discharges are to be expected,
someone might be choosing
a different hospice
or even opting to pursue curative
care again.
But experts told us a live discharge
rate of more than 30% is high,
and anything over 50 is a serious
red flag for possible fraud.
And yet, an analysis in California
found that last year,
more than 500 hospices there had
a live discharge rate
greater than 70%,
with 135 having
a 100% live discharge rate.
Which is wild. Once 100% of people
in your care are leaving alive,
you're not a hospice, you're a hotel.
And statistically,
an incredibly safe one.
And there are horror stories where
patients have been kept in hospice
when they clearly didn't need to be.
Take what happened
to Patricia Marble.
After her doctor recommended
hospice for her,
she signed on with a company
called Amedisys.
But as the years went by, her daughter
realized something might be up.
My mom trusted her nurse.
My mom trusted these people.
Trusting them so much Marble says
she didn't question the long list
of drugs, including fentanyl and
morphine to make her comfortable.
The hydrocodone.
They sat next to her and told her she
could take it whenever she was in pain.
Medical records shared
with Fox 25 Investigates show
Marble remained in hospice care
for five years.
Then earlier this year, Bragg said
she went against
the hospice nurse's orders and finally
took her mom to an outside doctor.
The doctors were telling me
that there's a problem,
that there's a problem with her being
on hospice for five years.
Meanwhile, 76-year-old Patricia Marble
is still very much alive.
- How are you feeling now?
- I'm feeling a whole lot better.
They just fed me the medication,
and I just took it myself,
like she told me.
It was surreal.
It just, all of a sudden,
this nurse turns into running
my household.
That is awful. She was in hospice
unnecessarily for five years,
with the company billing Medicare
almost half a million dollars for her.
That should never happen.
There is a reason that you've never
seen a lawn sign that says,
"In this house, love is love,
science is real,
and we're being held prisoner
by hospice nurses, please send help."
Now, I do have to tell you,
Amedisys insisted at the time
that allegations that she was
discouraged from seeing
an outside physician were
"completely false,"
though they did enter a confidential
settlement with the family,
which hopefully that woman
got to enjoy,
because she lived for seven
more years after that segment aired.
And it can be even easier than that
to end up in hospice unnecessarily.
Because they're supposed to admit
a patient on the recommendation
of their medical director,
in consultation with
the patient's own physician, if any.
But if that "any" doesn't exist,
or isn't available,
then the whole decision might come
down to a doctor
on the hospice's payroll.
There've been multiple cases where
doctors have accepted bribes
or kickbacks to refer and recertify
patients who didn't need care,
including in this incredible video.
You are looking at undercover video
of a doctor accepting kickbacks
for referring patients to hospice care,
patients who don't need it.
We were expecting a lot more than that.
But, doc, you need to help me
get some patients in the door.
I just gave you nine patients.
You know how much I can get from
somebody else for nine patients?
250 bucks a piece.
That is a doctor essentially selling
his patients to a hospice agency.
And I know that this is not remotely
the point,
but honestly, kind of low-balling it.
Because $250?
That's it? You're selling human beings,
not a pair of fucking AirPods.
That same doctor served as a medical
director for a different hospice group
where several nurses testified
that the vast majority of patients
were not terminally ill, including one
who had a regular job at Walmart.
The group even enrolled patients
with illnesses
such as Alzheimer's and dementia
"by falsely telling them they had
less than six months to live,"
and sent chaplains
to lie to the patients
and discuss last rites and
preparations for their imminent death.
Which is horrendous.
Frankly, anyone who knowingly took
part in that deserves to rot in hell.
Except, sadly, we now know
that hell doesn't exist.
So, where's the next worst place?
Tampa, I guess.
They deserve to rot in Tampa.
And some hospices don't even bother
lying to patients
about their diagnoses, they just
enroll people anyway.
Hospices have been found
to enlist family and friends
to act as make-believe clients,
lure addicts to enroll with the promise
of free painkillers,
dupe people into the program
by claiming it's free home healthcare,
and have even stolen personal
information to enroll phantom patients.
Essentially engaging in identity theft.
That is how people have been enrolled
in hospice without even knowing it.
In Mississippi, a 29-year-old pregnant
woman learned she'd been enrolled
in something called
"Revelation Hospice,"
only when she visited her doctor
for a blood test.
And I will say: if you're gonna
unexpectedly discover
you're a hospice patient, there's just
no more fitting name
than "Revelation Hospice".
The only way it could've been more
on the nose is if it were called
the "Surprise, Bitch!
You're in hospice!" hospice.
And while that's clearly ridiculous,
it can also be dangerous.
As this journalist points out,
while enrolling in a hospice does give
you access to certain types of care,
it also prohibits you from others.
Hospice, it provides
only palliative care, not curative care.
So, if you sign up for hospice,
you lose your regular medical coverage.
And in one case, a woman lost
her place on a transplant waiting list.
So, it has real ramifications.
Yeah, you can lose your access
to life-saving treatment
if you enter hospice.
Which makes it extra-brutal when you
consider that, as you have just seen,
people can be signed up
without their knowledge.
A cancer patient lost access
to chemotherapy treatment
after being put in hospice without
his knowledge
and others were denied kidney
dialysis, mammograms,
and coverage
for life-saving medications.
And those just aren't things you should
be able to lose without realizing.
Chemotherapy isn't like a set of keys
or the wife of the head
of the Church of Scientology.
Where's Shelly, David?
Where's Shelly? It's been 17 years.
I'm starting to think
something bad's happened.
Now, the government does
have some controls in place.
For instance, to discourage hospices
from enrolling healthy people
indefinitely, it penalizes ones where
the average stay of patients
exceeds six months.
It's not a bad idea, in theory.
Unfortunately, in practice, some
hospices have found ways
to get that average down,
like padding out their roster
with new patients,
or even worse, dumping or discharging
those who are staying too long,
even if they genuinely need care.
The CEO of one company, Novus
Health Services in Frisco, Texas,
wasn't shy about encouraging his
employees to get patients out the door
to reduce that average length of stay.
These are the offices of Novus
Health Care Services in Frisco.
Its website says it offers hospice
and home health care services
all over North Texas.
Brad Harris founded the company.
This is his public profile picture
on Facebook.
The FBI quotes Harris
as telling one worker,
"You need to make this patient
go bye-bye."
In another case,
asking healthcare executives
to "find patients who would die
within 24 hours",
saying of one of his patients,
"if this fucker would just die".
Holy shit.
Look, you could say that Brad Harris
is a greedy heartless monster,
but nothing you could call him
will ever be as insulting
as featuring this photo
in that news report,
a photo in which he somehow
appears to be drunk, high,
and shitting himself
all at the same time.
I've seen newscasts use
nicer photos for school shooters.
NBC 5 Local News
is fucking vicious.
But one of the key problems here is,
outside of major fraud cases
like that,
there are shockingly few
consequences for bad behavior
and the barriers to operating a hospice
can be much lower than you'd think.
For instance, a medical background
isn't required to enter the business.
And Medicare only requires
that hospices be inspected
once every three years.
And some appear to skirt
even the most basic requirements.
For instance, state licensing laws
require that hospices
at least have a physical office. Which
doesn't feel like too much to ask.
But a recent audit in California found
112 hospices all shared the address
of this building in Van Nuys.
Which is ridiculous.
That building cannot hold 112 hospices.
Unless of course they're owned
and operated
by mice working within the walls.
That's right: mouse hospice, you can
have that one for free, Pixar!
It's like "Ratatouille" meets
the first 10 minutes of "Up!"
Why aren't you already making it?!
And by this point,
I think it is pretty clear,
we've strayed a long way from the ideal
with which this tire-slasher started.
So what can we do? Well,
some states are trying to fix things,
though those plans can often run
into opposition.
In Connecticut, a bill that would've
merely required a study
about banning private equity ownership
of hospices stalled out last year,
after opposition from
Republicans like this man.
The suggestion that somehow
the profit motive
is somehow adversely impacts
the quality of a business
is a very dangerous thing
to do in America.
If people didn't invent things,
didn't come up with new cures,
then they would not exist.
And if you don't have a reason
to create those things, then you won't.
This is America.
This is a free market country.
This is a capitalist country.
This is not a socialist country,
and it will not be if I can help it.
Right, he voted no because
he believes in the ideals of America,
is also why, and this is true, last
year, he was the lone "no" vote
in the state senate on a resolution
exonerating the victims
of the 17th century
Connecticut witch trials,
partly because, and I quote,
he didn't want
to "paint America as a bad place
with a bad history."
And I don't know what's weirder there,
the fact that he did that,
or the fact that Connecticut
didn't bother to exonerate victims
of witch trials until last year.
What happened that made them
suddenly decide to address this?
"You know, I've always assumed the
women we murdered in the 1600s
were guilty of witchcraft,
but then I saw Barbie,
and about halfway through
that America Ferrera speech,
I thought, 'Oh shit! The witches!
We should really get on that!'"
But thankfully there has been some
progress. At the federal level,
CMS embarked on a project to make
unannounced site visits
to every Medicare-enrolled hospice,
and as a result,
it's since revoked the Medicare
enrollment of 48 of them,
with nearly 500 more having their
Medicare billing privileges deactivated,
and requiring another inspection
before they can bill again.
Which is a good start.
California's also placed a moratorium
on new hospice licenses,
although there is concern that bad
actors are simply expanding
into less-regulated states like
Arizona, Nevada, and Texas instead.
And experts say there is still so much
more that we should be doing here,
including targeting hospices
with especially high live-discharge
rates for particular scrutiny.
And it's important that
these changes are made,
because, to reiterate, hospice care,
when done well,
is hugely beneficial to those who
are dying and their families.
It is too important to just hope
the free market fixes it.
And if you or someone you know
is looking for hospice care,
I'm afraid that right now,
your best bet might be to rely
on word-of-mouth recommendations.
And if those aren't available to you,
you can consult this government
website.
It's not perfect, but it can at least
give you some info
on the hospice you're considering.
And if there is little
to no information about it,
that might be a sign that they are not
reporting their quality data
to Medicare, so I would strongly
consider looking somewhere else.
Look, this industry badly needs reform.
That's clear.
And until that happens,
at the very least,
hospice ads should be required
to paint a much more accurate picture,
even if that picture ends up
looking like this.
If there was one thing I could do over,
I would have reached out sooner
for my husband.
I wanted to be with him again.
To really be with him. To sit with him.
To hold his hands.
To introduce some sliced vegetables
into our foreplay routine.
That's why we turned
to Hearts in Hands Hospice Care
and Sewage Solutions.
Here at Hearts in Hands Hospice
Care and Sewage Solutions,
we're proud to be with you
every step of the way.
Well, not always, you know,
literally there.
We might call you once in a while to
check in, but that's not a guarantee.
We love our patients so much. It's truly
heartbreaking when they pass away,
I assume.
I've never actually seen that happen.
Because last year we had
a 100% live discharge rate,
which, the more I think about it,
is a little weird.
It's not that weird.
And once you're enrolled with us,
you'll receive excellent care.
And don't just take that from me,
take it from some of our patients.
Hearts in Hands is amazing.
Grandma was just sitting on her porch
minding her own business
when this man came up
and enrolled her.
It was that fast! We almost
didn't know what we were signing.
They've been making sure
my final six months were comfortable
for the last eight years.
I mean, to be honest, I don't think
I would have even noticed
if any social workers
or nurses had shown up.
We've been too busy fucking.
My body is dying,
but my penis is not.
We've been fucking everywhere.
On the couch, in the kitchen.
In the minivan. By the hot tub.
- In the foyer.
- By the trash cans.
- That seat you're sitting in.
- Don't sit there.
- Walks by the lake.
- Especially walks by the lake.
We like to get caught by joggers.
We act like we're mad.
"Hey, what are you looking at?"
"Oh, God, stop it."
What are you looking at, pervert?
The point is, we go above and beyond
to bring joy
and comfort to our patients.
We can even hook you up with
an emotional support flamingo.
Why do we have a flamingo? I never
wanted to see a flamingo up close.
Yeah, that feels clear to me now.
Look, the flamingo was fine.
But I think she'd have been happier
if the hospice had provided drugs
or nurses or doctors.
But no, it was just Coconut
the flamingo.
And honestly, Coconut was pretty
useless when Grandma had a seizure.
Oh my God! Grandma!
Coconut! Do something!
You stupid shit fuck!
Why are you here!?
Our business is making sure you get
to make the most of your final days.
Or, more specifically, that we get to
make the most out of your final days.
You're going to hell.
Hell doesn't exist, fella. Okay?
I got that from a reliable source.
Funny story, I wasn't even
supposed to be in hospice.
Turned out my doctor
took a bribe to sign me up.
That makes sense. I mean, a sick man
couldn't cum this many times a day.
- No, he would die of dehydration.
- I cum so much.
Wait, so you're not dying?
No. I'm fine. You wanna do it again?
No, I'm fucking tired.
Hearts in Hands Hospice Care
and Sewage Solutions.
Honestly, we're better
at the sewage part.
That's our show,
thanks so much for watching!
We're off for the next two weeks,
we're back September 8th! Good night!
Are you thirsty?
I'm so thirsty.
Let me get some of that.
Get your own.
Oh my God. Oh, that's good.
So many fluids in my mouth.
Let's go!
Money is so awesome.
I'm John Oliver.
Thank you so much for joining us.
It has been a busy week.
Ukraine continued to push
into Russian territory,
the internet tried to figure out
what happened behind the scenes
on this movie,
and the Trump campaign continued
trying to counter enthusiasm
for the Democrats' new ticket
with JD Vance,
a man who perpetually looks like
he got stuck 10% of the way
to transforming into a werewolf,
desperately trying to spin the joy
of Harris' recent rallies as a negative.
She says she's having fun.
Well, while she's having fun,
Americans are suffering
under her policies.
When she laughs during a speech,
remember that there are American
families crying this very day
because they cannot afford
groceries.
When she does these rallies
and does these events
and does these fake dances,
remember that there are parents who
lost their children to drugs or violence
who will never see their children
move again, much less dance again.
What are you doing? Scolding people
for enjoying stuff
because there are sadder things
happening elsewhere
is a shitty thing to do, although
it does make me curious
what Vance is like
in other social situations.
"All right kids, enjoy SeaWorld, meet us
back here at 2:00 and remember
dolphins will sometimes kill porpoises
for sport! Have fun!
Scientists call it porpicide,
by the way!"
Also, for what it's worth, bumming
everyone out with depressing facts
about things you like isn't how
you become vice president,
it's how you put people
to sleep once a week
while aging like a wartime president.
Get the fuck off my corner!
The Trump-Vance campaign
has also been trying to deflect charges
of Republicans being weird.
Just last week Trump told a rally,
"I think we're the opposite of weird,
they're weird".
And told a radio host,
"Nobody's ever called me weird.
I'm a lot of things,
but weird I'm not."
So, you know it's getting to him. But
also, nobody's ever called you weird?
Babe, be serious.
You tried to buy Greenland,
you stared at the sun during
a solar eclipse, and you did this.
That's not something
a normal guy does.
I don't know what a normal guy
would do, because I'm also not one,
but I know it's not that.
The "weird" label has been
particularly hard to shake,
because Republican candidates further
down the ballot keep compounding it,
including some who won primaries
just this week,
like Royce White.
He became Minnesota's Republican
Senate candidate, and he is a lot.
He's a former NBA player,
far-right podcaster,
and a die-hard Trump supporter,
as he will tell you.
Donald Trump could get up on stage,
pull his pants down,
take a shit up at the podium,
and I still would never vote
for you fucking Democrats again.
Let that sink in.
Okay, okay, I'm letting it sink in.
All right, it's sunk in now,
and I do still have some questions.
Is there a place where Trump
could take a shit
that would make you vote
for Democrats again?
Like on a merry-go-round,
would that make you vote for them?
Or if he shit inside a gumball machine,
would you vote for Democrats then?
Or if he went into your bathroom,
put the toilet lid down,
and shit on the toilet instead of in it,
would you at least consider voting
for an independent who caucuses
with the Democrats?
You know what? Let that sink in
and just get back to me.
White's been endorsed
by Steve Bannon and Alex Jones,
whom he once supported by writing
this message on the side of his head.
He's also said, among other things,
that he's not sure if a plane hit
the Pentagon on 9/11,
claiming there's no footage of it,
which, of course, there very much is,
and he even once tweeted out this map
he claimed showed "crime in
Minneapolis" is out of control",
which turned out to be a map
of the city's drinking fountains.
Which is embarrassing. There are so
many real crime maps he could've used,
like this one, except, I'm kidding,
that's New York's rat information
portal, you idiot!
You just got schooled by the rat map!
Rat map!
But White is just one of a number
of odd GOP Senate candidates.
In Virginia, there's Hung Cao,
a retired Navy captain
with no political experience,
who's also a very strange man.
We can't let it turn like this.
There's a place in Monterey,
California called Lovers Point.
The original name
was "Lovers of Christ Point",
but they took out the Christ,
it's Lovers Point.
Monterey's a very dark place now.
A lot of witchcraft. The Wiccan
community has really taken over there.
And we can't let that happen
in Virginia.
If Monterey is actually overrun
by witches, which it's not,
I'm frankly furious there wasn't
a witchcraft storyline
on Big Little Lies.
How could you deprive us of Nicole
Kidman showing up to a moonlit orgy
and announcing,
"We come to this place for magic"?
Everyone's head would've exploded.
And while Cao and White
are unlikely to win,
other Republican candidates
like Eric Hovde,
Ned Flanders without
the raw sexual charisma,
do have a real shot.
This week, he won Wisconsin's
Senate primary in a landslide.
He's the wealthy CEO
of a bank called Sunwest,
so he's self-financing his campaign.
And he's taken some flak not just for
owning a property in California,
but spending a significant
amount of time there,
something he tried to deflect
with this video.
It's good to get out here
for a good cold plunge.
So, the Dems and Senator Baldwin
keep saying I'm not from Wisconsin.
Which is a complete joke.
All right, Senator Baldwin, why don't
you get here in this frozen lake
and let's really see
who's from Wisconsin?
I hope everyone has a great day.
Take care.
Well, now I'm having a terrible day,
'cause I did not want to see that.
Why physically torture yourself
to prove you're from Wisconsin,
when your incredibly strong accent
does that on its own?
Also, challenging someone
to meet you in a frozen lake
to score political points is pathetic.
I'd say it was a dick-measuring contest,
but I'm guessing, given the temperature
of that water,
yours has disappeared
into your body right now.
Hovde's views are what you'd expect
from a Republican candidate,
from supporting repealing
the Affordable Care Act,
to blaming immigrants for
"all the crime that has unfolded".
But he can also be pretty awkward
with voters,
like when he showed up
at a Juneteenth celebration,
and a radio host tried to feed him
softball questions.
And I'm gonna warn you, this is
extremely uncomfortable to watch.
What is a few of your takeaways
from being down here
at the Juneteenth parade here?
It's a hell of a good party,
and I'm really enjoying it, man.
All these little entrepreneurs
selling their wares,
really friendly people,
great food.
Is there anything you're going
to take away from this
that you didn't know about Black
culture before?
Look, I've spent a lot of time
in Black culture, and as Torey knows,
I've spent a lot of time in places
like Africa
because I have homeless shelters
for abandoned kids
and rescuing kids out of the streets.
And I've been involved in schooling,
charter schools and things
of that nature.
Stop talking, Eric! Stop talking!
You're hurting me to hear that!
There are so many easy answers
to the question
"What have you learned
about Black culture today?"
and among the worst is definitely,
"Not much, because I've already been
to Africa."
Fun fact: Black American culture
isn't actually synonymous
with African culture.
If you want to know why,
just Google "Juneteenth"
or ask one of the, quote,
"little entrepreneurs" you just met.
They'll fill you in.
I get Republicans want to get out from
under accusations of weirdness.
But the way to do that is to stop
being so fucking weird.
Because fantasizing about your party's
candidate shitting in front of you?
That's weird.
Warning everyone about the influence
of Monterey witches? Weird!
Inviting your female opponent
to join you in a frozen lake?
That is very weird!
And I do apologize for laughing
at these people,
partly because I know it's not nice.
But mainly because,
as we all now know,
JD Vance believes every time
someone laughs,
somewhere in the world, a child loses
their groceries for some reason.
And now, this.
And Now: Newscasters Come to Terms
with Life After the Olympics.
And just like that, the Olympics
are almost over.
What am I going to do with all my time
now that the Olympics are over?
- Probably go back to Taylor Swift.
- I guess I'll have to.
- Now you got nothing to watch.
- I don't know what I'm do.
And it's just one of those things
that kind of unites everybody.
You know, temporarily. Now we can go
back to hating each other.
I'm kind of sad the Olympics are over.
It was so much fun.
There were some personal benefits
to the Olympics,
like we didn't have a 30-minute news
program for two straight weeks.
- I miss the Olympics.
- Do you?
- Yeah, I do.
- They'll be back in four years, Ron.
- In LA.
- Hopefully, I'll be back in four years.
I am so glad the Olympics are over
because I'm tired of crying.
Watching the Team USA on the track.
Especially the women's teams, just
smashing gold after gold after gold.
I'm tired. They're tired.
They're a little more tired than I am,
but, you know.
All right, 4:05 this morning, crews have
removed the massive whale carcass
that washed up ashore
in Torrance Beach.
Moving on. Our main story tonight
concerns death.
The answer to the question,
"What does the interior
of an IHOP smell like?"
Lots of us have questions
about death. And luckily,
this nurse on TikTok can answer
at least one of them.
Hey, good news to all you sinners
out there,
I have never seen anyone dying start
seeing signs
that they are going to hell,
demons, fire, anything like that.
So, I think we're good.
Are you sure about that, though?
Because maybe patients
aren't telling you what they see.
I get why someone wouldn't want
their last words to be,
"Oh no, there's fire, there's Hitler,
Jeffrey Epstein,
Is that my childhood dog, Rusty?
What're you doing here?
And why does Charles Manson look
like he respects you?
What did you do, Rusty? Bad boy!"
That nurse actually works for the type
of medical business
we'll be focusing on tonight: hospice.
I realize that doing an episode about
hospice is an almost offensive parody
of this show, if somebody else did
that, it would genuinely be hurtful.
But I promise,
this is worth talking about.
And you're probably at least somewhat
familiar with the concept of hospice,
it's end-of-life care that helps
terminally ill people die comfortably.
You may even have seen ads
for hospice on TV.
And if you live
in southeast Connecticut,
you might have seen this
weirdly horny one.
If there was one thing I could do over,
I would have reached out sooner
to Center for Hospice Care
for my husband.
When Center for Hospice Care
came into our life,
it allowed me to be with him.
To really be with him, without having
to coordinate all his care.
Their nurses, social workers,
and other caregivers gave me
the freedom to be his wife again.
To love him like a wife.
That is, and I say this
with absolute certainty,
the single horniest hospice ad
I've ever seen,
from the fervid hand-humping
to this absolute masterclass
in eye-fucking, to the erotic
vegetable-themed foreplay.
That looks less like a hospice ad
and more like a VHS tape called
"Tantric Sex for Couples Over 50".
Hospice is designed for those
with terminal illness who choose
not to get treatment
to cure or control it,
and it's meant to provide support
for the person and their family,
including relief of symptoms and pain.
And that support can take many forms,
even allowing for moments like this.
A hospice patient got a special visitor.
Peggy Garrison loves flamingos.
She pays homage
to the majestic animals
with the 158 trinkets and decorations
she's collected throughout her life.
Now that the 75-year-old
is in the final stages of cancer,
a flamingo named Mango paid her
a visit from the San Antonio Zoo.
The San Antonio Zoo said it was happy
to allow Mango to meet Peggy
to honor the life she spent
loving these animals.
That is great! I love that
that happened for Peggy!
Although, do spare a quick thought
for Mango the flamingo there.
Imagine you went to the home
of someone that you didn't know
and they had 158 images
of you everywhere.
You'd definitely think you were
about to get murdered.
That woman and her family
had a positive experience
with their hospice provider.
And the good news is,
many, many people do.
Lots of dedicated people work
with hospices,
providing huge relief for dying
patients and their families,
particularly those who want to remain
at home, where, in most cases,
hospice care is provided.
About 1.8 million Medicare beneficiaries
now receive hospice care each year.
In fact, you'll probably encounter
hospice at some point in your life,
either for yourself, or for a loved one.
And at its best, it is great.
Unfortunately, at its worst, it is not,
as the hospice industry has become
riddled with stories like these.
A local company agrees
to a $75 million settlement
over alleged overbilling
of hospice services.
A Cleveland doctor has been
sentenced to five years in prison
for healthcare fraud connected
to hospice operations
in the state's impoverished
delta region.
California's attorney general
is announcing the arrest
of over a dozen people accused
of running a hospice scam
in the Inland Empire.
It's true.
There is a lot of hospice fraud.
A sentence, by the way, recently
voted "least hot"
by Things to Whisper Into Your
Partner's Ear During Sex Magazine.
But it is true,
there's a lot of hospice fraud.
In fact, one government report
estimated
that hospices' inappropriate billing
costs Medicare
hundreds of millions of dollars a year,
and experts say they believe
that figure to be far higher.
And the financial consequences
here are the least of the problems.
So, given that, tonight,
let's look at hospice care,
how it's supposed to work, and what,
too often, is happening instead.
And let's start with the fact that
hospice, as we know it, is pretty new.
Here's a TV report from 1979,
explaining it to Americans
as if for the first time.
A new concept for taking care of
terminally ill patients
is gaining interest in this country.
It is called hospice and comes to us
by way of England.
The philosophy behind hospice is that
once death has become inevitable,
patients should be treated with
great attention to their comfort
and emotional needs.
Yeah, hospice actually came
from England!
And I know the British exporting
a new way to die sounds like
the perfect slogan for over 400 years
of colonialism,
but in this case,
it was genuinely a good thing.
The concept was originally conceived
by dame Cicely Saunders,
seen here looking like
she just slashed your tires.
She was an English doctor
and social worker,
who'd been upset by the "wretched
habits of big, busy hospitals
where everyone tiptoes past
the bed and the dying soon learn
to pretend to be asleep."
Which sounds bleak but, remember,
that was in the U.K.,
home of the famous war-time poster:
"Keep quiet and die."
The idea eventually migrated over here
and the first American hospice
began caring for patients in 1974.
More soon followed, mainly consisting
of "a constellation of charities,
mostly reliant on volunteers."
But in 1982,
Reagan made a big change,
when he authorized Medicare
to cover the cost of hospice,
after advocates convinced lawmakers
"it would be cheaper for Medicare than
paying for the aggressive treatment
that so many patients received
up until they died."
That move meant there was now
a lot more money to be made
in the hospice business.
And today, of the country's
roughly 6,000 providers,
three-quarters are for-profit.
One of the biggest and earliest
was Vitas,
which was founded by two teachers
and Don Gaetz,
who is, fun fact, Matt Gaetz's dad.
Which is kind of surprising.
I didn't think Gaetz had parents
in the traditional sense,
I just assumed someone jizzed
on a "Goodfellas" poster.
Vitas made its founders
extremely wealthy.
In 2004, it sold for $406 million
to Chemed,
best known as the owner
of Roto-Rooter, a plumbing company.
In fact, on Glassdoor,
Chemed is described as bringing
"a professional dignity to times
of transition and sewer line clogs."
So, now you know who to call
if you're facing your own mortality
and/or a backed-up shit pipe!
The point is,
hospices can be big business.
And it's worth talking about exactly
how they make money.
Basically, once you're enrolled
in a hospice,
they get a flat fee every day
for routine care.
It's a little over $200 a day
for the first 60 days,
and a little less for however long
you're in hospice after that.
And that can create a clear incentive
to sign up as many patients as possible.
A marketer for one hospice in Georgia
was even recorded telling a sales rep,
"How do you solicit patients?
You see somebody sitting on the front
porch in a wheelchair
and you hit the brakes."
And you know our system is broken
when a hospice provider's target demo
is kidnapped porch grandmas.
One big way hospices can get referrals,
though, is by befriending staffs
at nursing homes
and doctors' offices.
In fact, Vitas has been particularly
aggressive in its sales tactics,
like when they were caught doing this
in the middle of 2020.
Text messages we obtained show
Vitas salespeople visiting
multiple Bay Area nursing homes and
doctors' offices during the pandemic.
They took numerous selfies
with healthcare workers,
some bringing gifts of pizza, chicken,
or doughnuts.
Under one picture,
a rep even wrote,
"Six boxes of these made their way
into a local nursing home
that isn't allowing food
in from the outside."
A fellow employee texted back,
"Sneaky, sneaky."
Another email shows a manager
running a weekend referral contest,
saying "whoever gets the most selfies"
with medical personnel could win.
Personnel including nursing home staff,
emergency room staff,
physicians, or nurses.
It's true. To get patient referrals,
they were sending sales reps
into nursing homes,
and encouraging them to get selfies
with healthcare workers
who were interacting with high-risk
populations, at the height of Covid.
That sounds like a plan literally
hatched by the coronavirus itself.
And incidentally, you know
what's not "sneaky, sneaky"?
Bragging about your unethical sales
tactics in writing,
that is more stupid, stupid.
So, that is just one way
hospices can make money,
getting as many patients as possible.
Another is to then spend as little
on those patients as you can.
Underwhelming care is a persistent
complaint about hospices,
with a recent survey finding over one
in five families said
their hospice agency did not always
provide timely help.
And recent investigations by HHS
have found some alarming examples
of neglect, like a hospice that billed
Medicare for 17 days of care
for a 70-year-old patient
that they never visited.
Instead, they just called his family
to inquire how he was doing.
And it is hard to defend the quality
of that company's service
when they were quite literally
phoning it in.
But it gets worse, because they also
found multiple cases of severe neglect,
like when a hospice skipped home visits
and failed to assess the amount
of pain one patient endured,
with that patient eventually suffering
a maggot infestation in his feeding tube
that required a trip
to the emergency room.
Which is horrifying! Treatment for
dying people ideally should not sound
like a scene from
a fucking "Saw" movie.
And providing subpar care
is bad enough.
But some hospices engage in
outright fraud, to overbill Medicare.
Because if patients require
a higher level of care,
hospices can bill the government
at a much higher rate,
as much as $1,500 a day
for "continuous home care",
sometimes called crisis care.
Vitas was even sued by the DOJ
in 2013
for billing Medicare for more
costly crisis care services
when certain patients
did not need them.
Over eight years, the government
says that Vitas generated
nearly a billion dollars in revenue
from crisis care,
and while the company didn't
admit wrongdoing,
it did pay $75 million
to settle that case.
The kind of thing that we all do when
we haven't done anything wrong.
And Vitas is by no means the only
company accused of doing this.
Passages Hospice used to be the
biggest hospice company in Illinois,
until this happened.
Passages Hospice in Moline forced out
of business today
after the indictment of one
of its owners on federal fraud charges.
Lawyer Seth Gillman of Lincolnwood
was charged by the feds last month
for allegedly overcharging Medicare
and Medicaid.
The company and its 300
workers statewide, history.
Gillman faces up to 15 years
if convicted.
I would describe him as
the lowest form of life.
He deserves what's coming to him.
You know how wretched
you have to be
for a middle-aged midwestern woman
to call you "the lowest form of life"?
She didn't even dress it up with
a "he's not my cup of tea"
or "I think he has a lot to answer for."
That is midwestern
for, "I hope he dies in pain,
and I'll personally block traffic
to ensure an empty funeral home."
Gillman was eventually sentenced to
six and a half years in federal prison
for masterminding
a $20 million fraud scheme
that included enrolling patients
in expensive in-patient care
they didn't need.
Families told reporters that Passages
employees even misled them
into believing their loved one
had serious or terminal illnesses,
when they didn't.
A federal court found Gillman
pocketed millions annually,
and enjoyed a lavish lifestyle
that included corporate airplanes,
and luxury sports cars,
behavior his own lawyer
in a court filing,
partly attributed to the fact he was
ingesting cocaine on a daily basis.
That was his defense!
Imagine how guilty you have to be
for your own lawyer to say,
"Your Honor, my client may
as well be Shaun White
the way he was shredding down
mountains of pure white powder,
I'm talking in his defense,
you understand."
But it's not just exaggerating
the amounts of care
that patients are getting,
hospices can also enroll patients
who shouldn't even be there
in the first place.
Because while there's a requirement
that patients have a life expectancy
of six months or less,
most of the Medicare spending
on hospice is now for patients
whose stays exceed six months.
And look, obviously, it is a good
thing when someone lives longer
than their prognosis.
This show is not pro-death.
To be honest, sometimes we are.
But most of the time, we are not.
But there are worrying signs some
hospices are enrolling patients
who don't need their care.
And one indicator of this is
the "live discharge rate",
basically, how many people leave
hospice alive.
Now, a small amount of live
discharges are to be expected,
someone might be choosing
a different hospice
or even opting to pursue curative
care again.
But experts told us a live discharge
rate of more than 30% is high,
and anything over 50 is a serious
red flag for possible fraud.
And yet, an analysis in California
found that last year,
more than 500 hospices there had
a live discharge rate
greater than 70%,
with 135 having
a 100% live discharge rate.
Which is wild. Once 100% of people
in your care are leaving alive,
you're not a hospice, you're a hotel.
And statistically,
an incredibly safe one.
And there are horror stories where
patients have been kept in hospice
when they clearly didn't need to be.
Take what happened
to Patricia Marble.
After her doctor recommended
hospice for her,
she signed on with a company
called Amedisys.
But as the years went by, her daughter
realized something might be up.
My mom trusted her nurse.
My mom trusted these people.
Trusting them so much Marble says
she didn't question the long list
of drugs, including fentanyl and
morphine to make her comfortable.
The hydrocodone.
They sat next to her and told her she
could take it whenever she was in pain.
Medical records shared
with Fox 25 Investigates show
Marble remained in hospice care
for five years.
Then earlier this year, Bragg said
she went against
the hospice nurse's orders and finally
took her mom to an outside doctor.
The doctors were telling me
that there's a problem,
that there's a problem with her being
on hospice for five years.
Meanwhile, 76-year-old Patricia Marble
is still very much alive.
- How are you feeling now?
- I'm feeling a whole lot better.
They just fed me the medication,
and I just took it myself,
like she told me.
It was surreal.
It just, all of a sudden,
this nurse turns into running
my household.
That is awful. She was in hospice
unnecessarily for five years,
with the company billing Medicare
almost half a million dollars for her.
That should never happen.
There is a reason that you've never
seen a lawn sign that says,
"In this house, love is love,
science is real,
and we're being held prisoner
by hospice nurses, please send help."
Now, I do have to tell you,
Amedisys insisted at the time
that allegations that she was
discouraged from seeing
an outside physician were
"completely false,"
though they did enter a confidential
settlement with the family,
which hopefully that woman
got to enjoy,
because she lived for seven
more years after that segment aired.
And it can be even easier than that
to end up in hospice unnecessarily.
Because they're supposed to admit
a patient on the recommendation
of their medical director,
in consultation with
the patient's own physician, if any.
But if that "any" doesn't exist,
or isn't available,
then the whole decision might come
down to a doctor
on the hospice's payroll.
There've been multiple cases where
doctors have accepted bribes
or kickbacks to refer and recertify
patients who didn't need care,
including in this incredible video.
You are looking at undercover video
of a doctor accepting kickbacks
for referring patients to hospice care,
patients who don't need it.
We were expecting a lot more than that.
But, doc, you need to help me
get some patients in the door.
I just gave you nine patients.
You know how much I can get from
somebody else for nine patients?
250 bucks a piece.
That is a doctor essentially selling
his patients to a hospice agency.
And I know that this is not remotely
the point,
but honestly, kind of low-balling it.
Because $250?
That's it? You're selling human beings,
not a pair of fucking AirPods.
That same doctor served as a medical
director for a different hospice group
where several nurses testified
that the vast majority of patients
were not terminally ill, including one
who had a regular job at Walmart.
The group even enrolled patients
with illnesses
such as Alzheimer's and dementia
"by falsely telling them they had
less than six months to live,"
and sent chaplains
to lie to the patients
and discuss last rites and
preparations for their imminent death.
Which is horrendous.
Frankly, anyone who knowingly took
part in that deserves to rot in hell.
Except, sadly, we now know
that hell doesn't exist.
So, where's the next worst place?
Tampa, I guess.
They deserve to rot in Tampa.
And some hospices don't even bother
lying to patients
about their diagnoses, they just
enroll people anyway.
Hospices have been found
to enlist family and friends
to act as make-believe clients,
lure addicts to enroll with the promise
of free painkillers,
dupe people into the program
by claiming it's free home healthcare,
and have even stolen personal
information to enroll phantom patients.
Essentially engaging in identity theft.
That is how people have been enrolled
in hospice without even knowing it.
In Mississippi, a 29-year-old pregnant
woman learned she'd been enrolled
in something called
"Revelation Hospice,"
only when she visited her doctor
for a blood test.
And I will say: if you're gonna
unexpectedly discover
you're a hospice patient, there's just
no more fitting name
than "Revelation Hospice".
The only way it could've been more
on the nose is if it were called
the "Surprise, Bitch!
You're in hospice!" hospice.
And while that's clearly ridiculous,
it can also be dangerous.
As this journalist points out,
while enrolling in a hospice does give
you access to certain types of care,
it also prohibits you from others.
Hospice, it provides
only palliative care, not curative care.
So, if you sign up for hospice,
you lose your regular medical coverage.
And in one case, a woman lost
her place on a transplant waiting list.
So, it has real ramifications.
Yeah, you can lose your access
to life-saving treatment
if you enter hospice.
Which makes it extra-brutal when you
consider that, as you have just seen,
people can be signed up
without their knowledge.
A cancer patient lost access
to chemotherapy treatment
after being put in hospice without
his knowledge
and others were denied kidney
dialysis, mammograms,
and coverage
for life-saving medications.
And those just aren't things you should
be able to lose without realizing.
Chemotherapy isn't like a set of keys
or the wife of the head
of the Church of Scientology.
Where's Shelly, David?
Where's Shelly? It's been 17 years.
I'm starting to think
something bad's happened.
Now, the government does
have some controls in place.
For instance, to discourage hospices
from enrolling healthy people
indefinitely, it penalizes ones where
the average stay of patients
exceeds six months.
It's not a bad idea, in theory.
Unfortunately, in practice, some
hospices have found ways
to get that average down,
like padding out their roster
with new patients,
or even worse, dumping or discharging
those who are staying too long,
even if they genuinely need care.
The CEO of one company, Novus
Health Services in Frisco, Texas,
wasn't shy about encouraging his
employees to get patients out the door
to reduce that average length of stay.
These are the offices of Novus
Health Care Services in Frisco.
Its website says it offers hospice
and home health care services
all over North Texas.
Brad Harris founded the company.
This is his public profile picture
on Facebook.
The FBI quotes Harris
as telling one worker,
"You need to make this patient
go bye-bye."
In another case,
asking healthcare executives
to "find patients who would die
within 24 hours",
saying of one of his patients,
"if this fucker would just die".
Holy shit.
Look, you could say that Brad Harris
is a greedy heartless monster,
but nothing you could call him
will ever be as insulting
as featuring this photo
in that news report,
a photo in which he somehow
appears to be drunk, high,
and shitting himself
all at the same time.
I've seen newscasts use
nicer photos for school shooters.
NBC 5 Local News
is fucking vicious.
But one of the key problems here is,
outside of major fraud cases
like that,
there are shockingly few
consequences for bad behavior
and the barriers to operating a hospice
can be much lower than you'd think.
For instance, a medical background
isn't required to enter the business.
And Medicare only requires
that hospices be inspected
once every three years.
And some appear to skirt
even the most basic requirements.
For instance, state licensing laws
require that hospices
at least have a physical office. Which
doesn't feel like too much to ask.
But a recent audit in California found
112 hospices all shared the address
of this building in Van Nuys.
Which is ridiculous.
That building cannot hold 112 hospices.
Unless of course they're owned
and operated
by mice working within the walls.
That's right: mouse hospice, you can
have that one for free, Pixar!
It's like "Ratatouille" meets
the first 10 minutes of "Up!"
Why aren't you already making it?!
And by this point,
I think it is pretty clear,
we've strayed a long way from the ideal
with which this tire-slasher started.
So what can we do? Well,
some states are trying to fix things,
though those plans can often run
into opposition.
In Connecticut, a bill that would've
merely required a study
about banning private equity ownership
of hospices stalled out last year,
after opposition from
Republicans like this man.
The suggestion that somehow
the profit motive
is somehow adversely impacts
the quality of a business
is a very dangerous thing
to do in America.
If people didn't invent things,
didn't come up with new cures,
then they would not exist.
And if you don't have a reason
to create those things, then you won't.
This is America.
This is a free market country.
This is a capitalist country.
This is not a socialist country,
and it will not be if I can help it.
Right, he voted no because
he believes in the ideals of America,
is also why, and this is true, last
year, he was the lone "no" vote
in the state senate on a resolution
exonerating the victims
of the 17th century
Connecticut witch trials,
partly because, and I quote,
he didn't want
to "paint America as a bad place
with a bad history."
And I don't know what's weirder there,
the fact that he did that,
or the fact that Connecticut
didn't bother to exonerate victims
of witch trials until last year.
What happened that made them
suddenly decide to address this?
"You know, I've always assumed the
women we murdered in the 1600s
were guilty of witchcraft,
but then I saw Barbie,
and about halfway through
that America Ferrera speech,
I thought, 'Oh shit! The witches!
We should really get on that!'"
But thankfully there has been some
progress. At the federal level,
CMS embarked on a project to make
unannounced site visits
to every Medicare-enrolled hospice,
and as a result,
it's since revoked the Medicare
enrollment of 48 of them,
with nearly 500 more having their
Medicare billing privileges deactivated,
and requiring another inspection
before they can bill again.
Which is a good start.
California's also placed a moratorium
on new hospice licenses,
although there is concern that bad
actors are simply expanding
into less-regulated states like
Arizona, Nevada, and Texas instead.
And experts say there is still so much
more that we should be doing here,
including targeting hospices
with especially high live-discharge
rates for particular scrutiny.
And it's important that
these changes are made,
because, to reiterate, hospice care,
when done well,
is hugely beneficial to those who
are dying and their families.
It is too important to just hope
the free market fixes it.
And if you or someone you know
is looking for hospice care,
I'm afraid that right now,
your best bet might be to rely
on word-of-mouth recommendations.
And if those aren't available to you,
you can consult this government
website.
It's not perfect, but it can at least
give you some info
on the hospice you're considering.
And if there is little
to no information about it,
that might be a sign that they are not
reporting their quality data
to Medicare, so I would strongly
consider looking somewhere else.
Look, this industry badly needs reform.
That's clear.
And until that happens,
at the very least,
hospice ads should be required
to paint a much more accurate picture,
even if that picture ends up
looking like this.
If there was one thing I could do over,
I would have reached out sooner
for my husband.
I wanted to be with him again.
To really be with him. To sit with him.
To hold his hands.
To introduce some sliced vegetables
into our foreplay routine.
That's why we turned
to Hearts in Hands Hospice Care
and Sewage Solutions.
Here at Hearts in Hands Hospice
Care and Sewage Solutions,
we're proud to be with you
every step of the way.
Well, not always, you know,
literally there.
We might call you once in a while to
check in, but that's not a guarantee.
We love our patients so much. It's truly
heartbreaking when they pass away,
I assume.
I've never actually seen that happen.
Because last year we had
a 100% live discharge rate,
which, the more I think about it,
is a little weird.
It's not that weird.
And once you're enrolled with us,
you'll receive excellent care.
And don't just take that from me,
take it from some of our patients.
Hearts in Hands is amazing.
Grandma was just sitting on her porch
minding her own business
when this man came up
and enrolled her.
It was that fast! We almost
didn't know what we were signing.
They've been making sure
my final six months were comfortable
for the last eight years.
I mean, to be honest, I don't think
I would have even noticed
if any social workers
or nurses had shown up.
We've been too busy fucking.
My body is dying,
but my penis is not.
We've been fucking everywhere.
On the couch, in the kitchen.
In the minivan. By the hot tub.
- In the foyer.
- By the trash cans.
- That seat you're sitting in.
- Don't sit there.
- Walks by the lake.
- Especially walks by the lake.
We like to get caught by joggers.
We act like we're mad.
"Hey, what are you looking at?"
"Oh, God, stop it."
What are you looking at, pervert?
The point is, we go above and beyond
to bring joy
and comfort to our patients.
We can even hook you up with
an emotional support flamingo.
Why do we have a flamingo? I never
wanted to see a flamingo up close.
Yeah, that feels clear to me now.
Look, the flamingo was fine.
But I think she'd have been happier
if the hospice had provided drugs
or nurses or doctors.
But no, it was just Coconut
the flamingo.
And honestly, Coconut was pretty
useless when Grandma had a seizure.
Oh my God! Grandma!
Coconut! Do something!
You stupid shit fuck!
Why are you here!?
Our business is making sure you get
to make the most of your final days.
Or, more specifically, that we get to
make the most out of your final days.
You're going to hell.
Hell doesn't exist, fella. Okay?
I got that from a reliable source.
Funny story, I wasn't even
supposed to be in hospice.
Turned out my doctor
took a bribe to sign me up.
That makes sense. I mean, a sick man
couldn't cum this many times a day.
- No, he would die of dehydration.
- I cum so much.
Wait, so you're not dying?
No. I'm fine. You wanna do it again?
No, I'm fucking tired.
Hearts in Hands Hospice Care
and Sewage Solutions.
Honestly, we're better
at the sewage part.
That's our show,
thanks so much for watching!
We're off for the next two weeks,
we're back September 8th! Good night!
Are you thirsty?
I'm so thirsty.
Let me get some of that.
Get your own.
Oh my God. Oh, that's good.
So many fluids in my mouth.
Let's go!
Money is so awesome.