Fourteen arrested in $4.2 million hospice scam

Fourteen arrested in $4.2 million hospice scam | Insurance Business America

Fourteen arrested in $4.2 million hospice scam

More than a dozen people have been arrested in a scam which saw two hospice companies allegedly steal more than $4.2 million from Medicare and Medicaid.

California Attorney General Rob Bonta on Thursday announced the arrests of 14 people who were charged in San Bernardino County Superior Court in connection with the scam. Two other defendants remain at large. All of the defendants face multiple felony counts, including conspiracy to commit insurance fraud, insurance fraud, grand theft, and fraudulent insurance claims. Some defendants also face charges related to money laundering, identity theft and tax evasion.

According to prosecutors, New Hope Hospice and Sterling Hospice Care, both based in San Bernardino County, enrolled patients who were not terminally ill into hospice care. Many of the patients told investigators that they were enrolled without their knowledge or without understanding what hospice care was.

“End-of-life care is a difficult process for families to endure, and patients should be able to trust that their hospice providers are acting in good faith,” Bonta said. “The crimes allegedly committed by the defendants against their patients, Medicare, and our state’s Medi-Cal program will not be tolerated. My office is committed to protecting the wellbeing of Californians and prosecuting those who abuse the financial integrity of our healthcare system.”

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According to Bonta’s office, an investigation led by the California Department of Justice revealed that, from 2015 to 2021, the defendants allegedly billed Medicare and Medicaid for millions of dollars, claiming they were providing hospice care to patients who had less than six months to live – when these patients were, in fact, not terminally ill.

The scam was a complex one, with several moving parts, including: paying illegal kickbacks to recruit patients for hospice care, including patients who didn’t qualify for hospice because they weren’t dying; taking patient identity information and using it to put them in hospice without their knowledge; falsely representing to patients the services they would receive; and billing patients with one hospice company, only to switch them to the other hospice company in order to avoid detection.

When patients are enrolled in hospice care, they give up the opportunity under the Medicare and Medi-Cal programs to receive treatment to prolong their life, such as chemotherapy for cancer patients. As a result of the alleged scam, numerous ineligible patients were fraudulently certified as terminally ill and tricked into receiving hospice services – which would have made access to potentially lifesaving medical care difficult had any of them required it.