State Auditor Identifies Crisis
Lack Of Oversight Leads To Fraud And Abuse
Wave Of For-Profit Hospice Agencies
Hospice agencies are paid to care for the dying. Hospice care is for those persons who are terminally ill and for whom death is imminent. Hospice care is not long-term; it normally occurs in the final weeks of a patient’s life. Medicare, Medi-Cal and private insurance cover hospice care, and sadly there are those hospice agencies that may take advantage of coverage to admit patients who are not terminally ill, or falsify the admissions paperwork in order to obtain payments. Once entered into hospice care, fraudulently certified patients may not receive the care they need. They become victims of fraud and neglect. Evans Law Firm, Inc. represents hospice patients and their families who are defrauded by unscrupulous agencies or neglected, abandoned or denied the medications they need because, contrary to the agency’s certification, they are not in reality terminally ill. Parties responsible for such fraud, abuse and neglect are liable for their actions under California Law. See Cal. Welf. & Inst. Code §§ 15610.07 (definition of abuse), 15610.57 (definition of neglect), and 15610.63 (definition of physical abuse); Cal. Gov’t Code § 12650 et seq. (California False Claims Act). The parties responsible for the fraud and abuse should be held accountable. If you have a loved one who has suffered from abuse or neglect in a hospice program in Los Angeles or elsewhere throughout California, call us today at (415)441-8669 or TOLL FREE 1-888-80EVANS (888-503-8267).
California State Auditor’s Report
A recent report by Michael Tilden, Acting California State Auditor, charged that there are hospice agency operators who are possibly acting fraudulently within the State and putting patients at risk of harm due to lack of appropriate care. The audit was prompted by a series of articles on hospice fraud and abuse by the Los Angeles Times in 2020. The report opens by stating: “Indicators strongly suggest that a network or networks of individual perpetrators in Los Angeles County are engaging in a large and organized effort to defraud the Medicare and Medi-Cal hospice programs. Such fraud places at risk the extremely vulnerable population of hospice patients.”
The report describes explosive growth of for-profit hospice agencies in Los Angeles County, fueled (according to the audit) by fraudulent providers. The County has 1,841 hospice agencies, a 1,589 percent increase since 2010, and a flood of thousands more hospice applications. According to the Report, a single office building in Van Nuys has more hospice agencies than the entire states of New York and Florida combined.
The financial impact of the conduct is significant. In 2019, according to the report, hospice agencies in Los Angeles County likely overbilled Medicare by $105 million and overbilled Medi-Cal millions more. According to the audit findings, trademark signs of hospice fraud were rampant: high rates of patients discharged alive; long durations of hospice services; employees working for a large number of hospice agencies; and rapid growth and excessive clustering of hospice agencies. Auditors further found that many hospice agencies may be using stolen identities of medical professionals. Auditors found that one medical director was identified as serving more than 30 hospice agencies, and a single person serves as the administrator for 27 different hospice agencies.
The human toll of this kind of fraud is staggering. If a patient who is not terminally ill is nevertheless admitted to hospice, he or she cannot get the medications needed to actually treat their illness. Moreover, when agencies admit more patients than they can handle, all the patients suffer from care problems and inattention due to understaffing and lack of resources. If you have a loved one who has suffered any kind of fraud or abuse or neglect in a nursing home or hospice program, call us at Evans Law Firm, Inc. right away at (415) 441-8669, or by email at firstname.lastname@example.org or TOLL FREE 1-888-80EVANS (888-503-8267).
 Patients and their families having credible information of any government fraud may also be able to bring a qui tam action on behalf of the State to recover money fraudulently paid out, and be eligible for a reward if the State recovers from the wrongdoers.