01/08/2015 07:44 am ET Updated Jan 08, 2015

Here Are The Hospices That Break The Most Rules

Missed appointments. Confidential records left out in the open, in shopping bags and stacked on shelves. A patient overdosed with 10 times the amount of prescribed pain medication.

These are some of the more than 31,000 violations turned up over the past decade by inspectors who oversee the nation’s sprawling network of more than 4,000 hospices, which provide end-of-life comfort care to more than 1 million patients a year. Yet as The Huffington Post revealed last week, hospices that are docked for major violations during inspections are almost never punished.

Since 2004, state health officials have conducted about 15,000 hospice inspections to confirm that they are following rules set by Medicare’s federal regulator. Yet The Centers for Medicare and Medicaid Services has punished just 16 hospices in the last decade for breaking health and safety standards, HuffPost found.

Some hospice violations, known as deficiencies, are minor. Many deal with paperwork problems. But HuffPost found that hospices that accumulated the most violations were also often cited for serious violations that threatened patient health and safety.

This map shows the 50 active and inactive hospices that had most violations identified by government inspectors since 2004. The Huffington Post reached out to all the top-violating hospices that are still active. Read their responses here.

Even the best-run health provider can sometimes run afoul of one of Medicare’s many rules. But some hospices, remarkably, have gone the entire decade without being cited at all. This map shows the 254 active hospices that weren’t cited for any violations over the past decade. The results are limited to hospices with at least two inspections over that time.

Just as accumulating many violations is not necessarily the mark of a bad hospice, a clean track record does not necessarily mean that a particular hospice offers better care than a peer institution. Inspections may be more or less rigorous, depending on the state and the individual carrying out the review. Some hospices shown here have also gone years without an inspection. Use Hospice Check find hospices near you and inspect their violation history.