No one cares . . . like YoloCares
By: Craig Dresang, CEO, YoloCares
A few weeks ago, a representative from a Fortune 500 managed care organization contacted a YoloCares family and directed them to discharge their mom from YoloCares. They asked the family to transfer their mom to a low-quality provider that is on their preferred provider list. The reason: YoloCares does not have a contract with this patient’s insurance company . . . despite multiple attempts made by YoloCares to secure a contract.
It is unfathomable that a healthcare company with $10 billion in revenue – claiming to specialize in government-sponsored health insurance programs — would put a family in this sort of distress and confusion while their loved-one is actively dying. But they did.
What on earth are some of these corporate managed care plans thinking? What will they tell the family of this 96-year-old woman who is in her final days of life and has already been receiving excellent care for three months? Perhaps they will say, “I am so sorry your mom is in the middle of dying, but you must change her hospice provider right now. Here’s a list of mostly subpar providers for you to review. We will have to change out your mom’s current hospital bed, oxygen, prescriptions, and supplies; and she will be assigned to a new care team, including a new nurse and physician who you’ve never met, right before she dies. Sound good?”
To avoid distress for the family, YoloCares promptly and urgently requested a contract with this southern California healthcare company. However, they responded by saying, “ . . . thank you again for your interest in becoming a provider. Our process for vetting new hospices remains closed. If in the future the network should open, we will keep your organization in mind.”
Stories like this set my hair on fire, so I decided to review and evaluate this healthcare company’s list of approved preferred providers. Here’s what I found:
- Out of 22 hospices on the company’s list of preferred providers, 11 have a 0-Star Rating from the Centers for Medicare/Medicaid. (Star ratings are given by CMS based on quality data and range from 0-5).
- 8 providers do not collect/report QUALITY DATA per CMS requirements.
- 7 providers maintain POOR (BELOW AVERAGE) QUALITY scores.
- 3 providers only have a 2-Star Rating via CMS.
- 1 provider is no longer in business.
- 1 provider was recently penalized by the State for misrepresenting its accreditation status.
- 1 provider is under an OIG investigation for fraud.
- 19 providers are inaccurately listed as COMMUNITY BASED. The legal and industry definition of community-based is:
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- Non-profit governance by an unpaid Board of Directors from the community
- Mandated and independent financial audits conducted annually
- Bereavement and other programs that are open and accessible to the public at-large
- Safety-net organizations that provide charity care and accept high-cost complicated cases
- Only 2 of the company’s preferred providers meet the definition of community-based.
Reviewing the company’s list of preferred providers raises more questions than answers. How are providers vetted and selected by managed healthcare plans? Why would YoloCares — a 50-year-old, community-based, 4-STAR agency with a national reputation for quality — not be invited into a seemingly secretive process for selecting providers? Is this a closed process? Why?
The issue captured in this story is part of a systemic problem. In California, the for-profit hospice industry is explosive. While some would argue that growth and the resulting competition is healthy, the average consumer is usually not aware of the quality divide that may separate one hospice from another. Simply put, California lawmakers have – until now — neglected the end-of-life care industry, but more importantly, they have failed the patients, families, and communities who need really good care and in-place safety nets for their most vulnerable residents.
Compare California’s roster of 2,000+ hospice providers to a state like Florida where there are fewer than 80. The Sunshine State boasts a population of 5 million seniors (21 percent of the population), while the Golden State has 6 million seniors (15 percent of the population). The proliferation of providers has been more pronounced in states that do not have Certificate of Need (CON) laws. States with CON programs, like Florida, regulate the number of hospices allowed in an area. Without such laws consumers are often preyed upon at their time of greatest need by bad actors. Worse, many bad actors make it onto a managed healthcare plan’s list of preferred providers.
Recent headlines detailing hospice fraud investigations across California are deeply troubling. State and federal authorities have uncovered criminal schemes involving sham operators who enrolled people who were not terminally ill, paid illegal kickbacks to secure admissions, billed millions of dollars for services never provided and, in some cases, used stolen identities to operate shell companies.
These investigations are necessary, long overdue and effective. Fraudulent hospice operators are being shut down, licenses revoked, and criminal charges filed. Accountability is essential. However, amid this justified scrutiny, it is critical not to lose sight of an equally important truth: Hospice fraud is not hospice care.
Legitimate hospice care exists to serve individuals facing life-limiting illness with compassion, dignity and clinical integrity. Ethical hospice providers follow strict Medicare and State regulations, require clear physician certification of eligibility and deliver care through interdisciplinary teams that support both patients and their families. This model has not changed — and it is not the source of the current crisis.
The greatest risk of today’s headlines is not only the harm caused by fraud itself, but also the fear and confusion they may create for families who genuinely need hospice support. Across California, providers are already seeing the consequences of misinformation: families delaying comfort care, declining appropriate services or attempting to manage the final stages of illness alone because they are unsure whom to trust.
Families should know that investigators themselves have emphasized that warning signs are often clear. Legitimate hospice care does not involve gifts, cash or incentives to enroll. It does not include pressure to remain on services without medical justification, vague or undocumented diagnoses, minimal physician involvement or care teams that are difficult to reach. When those red flags appear, something is wrong.
Just as important, there are clear ways to identify ethical hospice providers. Families can protect themselves by taking a few simple, informed steps:
- Review Medicare Care Compare ratings and quality data @ www.medicare.gov/care-compare.
- The California Department of Public Health has a Cal Health Find Database where consumers can look up any hospice provider in the state.
- Ask how long the hospice has served the community.
- Ask about accreditation and quality standards.
- Confirm availability of after-hours support and caregiver assistance.
- Choose providers with an established local reputation.
Communities can and should feel confident choosing providers with deep local roots, transparent practices, and a long-standing commitment to ethical care. Nonprofit, community-based hospices — many of which have served their regions for decades — operate fundamentally differently from the “paper hospices” now being exposed. Their mission is to care for people, not to exploit a payment system.
When delivered properly, hospice care remains one of the most compassionate and human services in health care. It eases suffering, supports families, and honors life even as it reaches its final chapter. Fraud threatens public trust — but it must not undermine access for those who truly need this care.
The solution is not to turn away from hospice. It is to hold fraudulent actors fully accountable while reaffirming the value of ethical, regulated, patient-centered hospice care — and ensuring families have the information they need to make informed, confident choices.
California can do both. In fact, it must.