After mining a database of inspection records, Huffington Post determined that hospices frequently go three years -- and sometimes much longer -- without any regulatory scrutiny. It also showed that when hospices break Medicare's rules, endangering the safety and even lives of their frail patients, they are virtually never punished. Medicare's regulator has punished a hospice provider just 16 times in the last decade, despite carrying out 15,000 inspections and identifying more than 31,000 violations. In each instance, the hospice's license was terminated -- the sole recourse for regulators when they confront a hospice that breaks the rules. The system of oversight designed to ensure sound practices in an industry that has quadrupled in size since 2000 simply has no means to assess fines or other punishments. The service, which at its best provides a caring, home-based alternative to hospitalization for terminally ill patients, is increasingly how Americans die. Yet virtually nothing is known about the quality of the companies providing that service. This story reveals to consumers those hospices that regulators have determined have the most problems -- and hopefully spurring government authorities to act.
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