Over a dozen individuals were detained in a fraud that has seen two hospice companies taking over $4.2 Million of Medicare and Medicaid.
On Thursday, California Attorney General Rob Bonta announced the arrests of 14 individuals who were prosecuted with fraud in San Bernardino County Superior Court for the alleged scam. The defendants all face several felony charges, including the conspiracy of committing insurance fraud, grand theft, and fraudulent insurance claims. A few defendants face charges connected to identity theft, tax evasion, and other tax-related crimes. Two others remain in hiding.
According to prosecutors, New Hope Hospice and Sterling Hospice Care, located in San Bernardino County, enrolled patients who weren’t terminally ill in hospice treatment. The majority of patients told investigators that they were admitted without knowing or knowing what hospice was.
“End-of-life treatment can be a challenging experience for families, and patients should be able and confident that their hospice care providers are acting with integrity,” Bonta said. “The criminal acts that the defendants are accused of committing towards their customers, Medicare, and our Medi-Cal state program are not allowed to go unpunished. My office is committed to ensuring the well-being of Californians and prosecuting those who have abused the integrity of our financial health system.”
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According to the office of Bonta, an investigation conducted by the California Department of Justice revealed that from 2015 until 2021, defendants have billed Medicare or Medicaid in the millions and claimed they provided hospice services to patients with just six or fewer months remaining to live – even though the patients were not in terminal sick
The fraud was a complicated one with a variety of elements, such as: making illegal kickbacks to attract patients for hospice, even those who did not be eligible for hospice care because they were not dying; obtaining patients’ personal information to enroll them in hospice care without their consent; presenting patients falsely about the services they could receive; and charging patients who were with one hospice and then transferring patients to the second hospice provider to stay out of the spotlight.
If patients enroll in the hospice program, they are giving up the possibility to participate in those Medicare and Medi-Cal programs to get treatments that can prolong their lives, including treatment for patients with cancer. In the course of the fraud, many non-eligible patients were falsely classified as terminally ill and then manipulated into receiving hospice services, which could have prevented them from accessing potentially life-saving medical treatment difficult if any patients needed it.