Earlier this month, federal agents uncovered a $50 million Medicare fraud scheme in Southern California and arrested eight healthcare workers (including both doctors and nurses). This story hit national news headlines, leaving people to wonder if these types of schemes are happening in other locations as well.
Not only is hospice fraud a legal concern, but it can feel quite personal since real patients were used as props in the scheme. This program is built to support patients who are dying, and the perpetrators took advantage of the system for their own financial gains.
The $50 Million Medicare Hospice Fraud Scheme: What Allegedly Happened
This fraud scheme has been nicknamed “Operation Never Say Die,” and 15 people in total were charged, and 8 people arrested in Southern California. The losses are estimated at around $50 million in taxpayer dollars. The allegations state that the healthcare team was recruiting people who did not have terminal illnesses and paid them cash kickbacks to act as hospice patients. Medicare was billed for services that were either never provided or medically unnecessary.
For example, one of the allegations happened in Anaheim, where a nurse was at a market recruiting patients and offering them $300 per month in cash and free healthcare services. Then Medicare was billed for end-of-life care, and the profits were taken by the healthcare team.
One of the nurses had an 85% non-death discharge rate, which is almost five times higher than the national average. This statistic is one of the red flags that triggered the investigation.
How Widespread Is the Hospice Fraud?
In Los Angeles County alone, more than 700 out of 1,800 hospice providers have triggered multiple fraud red flags. Some of these hospice providers are clustered in single buildings. For example, one building had 89 registered hospice companies under the same roof.
At this point, CMS has already suspended 221 hospice licenses, and they will continue to review every hospice facility in the state of California.
Signs of Healthcare Fraud That Patients and Families Should Know
Even though this fraud scheme happened in Southern California, it’s possible that other types of fraud could be happening around the country. If you have a loved one enrolled in hospice or receiving ongoing medical care, it’s critical to understand what is happening every step of the way. One red flag is that a person is enrolled in the hospice program when they don’t have a clear terminal diagnosis.
Also, watch out for healthcare providers that are offering cash payments, gift cards, or free services in exchange for enrolling in Medicare programs. These kickbacks are illegal.
Another sign that Medicare fraud might be occurring is if the medical records seem inflated or inaccurate based on the patient’s actual health condition. It’s possible that the medical team might be billing for treatments or services that aren’t actually necessary or administered. For example, the California healthcare fraud investigation team found records that showed some providers billing for services and visits that never actually happened. The families found these discrepancies when they reviewed the Medicare explanation-of-benefits statements.
As a patient or a family member of a patient, always trust your gut if something feels off with the hospice enrollment or medical billing process. There are reasons to be concerned if the process feels rushed or unexplained, or you might notice that the healthcare team seems financially motivated.
What Happens to Patients Caught in the Middle of Hospice Fraud?
The consequences of getting caught in the middle of a healthcare fraud scheme can be serious, especially for patients who were enrolled fraudulently and denied legitimate medical treatment (because hospice requires that the patient skip curative treatment). If a healthy patient were placed in one of these hospice programs, then it could result in a missed diagnosis or delayed care.
If you or a loved one was used in any type of medical fraud scheme, then it’s important to know that you have legal rights. The legal protections are even stronger for patients who suffered harm because of improper medical care or medical services that were withheld as a result of the fraud.
FAQs
Can a patient or family member sue if a loved one was enrolled in a fraudulent hospice without their full consent?
There’s a possibility that you might have a legal case if a loved one was fraudulently enrolled in a hospice program. Contact our legal team right away if the patient suffered harm or was denied other medical care.
What should I do if I suspect a hospice provider is committing Medicare fraud?
If you suspect Medicare hospice billing fraud, then you should report your concerns as soon as possible. The simplest solution is to consult with a healthcare attorney so the proper methods can be followed to report the situation to the right authorities.
How do I know if my loved one’s hospice enrollment was legitimate?
Always ask for copies of the Medicare paperwork and medical reports. Look at the terminal diagnosis details as well as any consent forms that were signed at the time of enrollment. If there are discrepancies in the documentation, then it’s a red flag that healthcare fraud might be occurring.
Could this type of fraud happen in Texas?
The unfortunate reality is that healthcare fraud is a nationwide problem. Currently, federal agencies have active investigations in multiple states. No matter where you live, you should be diligent about reviewing medical records, Medicare statements, and hospice enrollment paperwork.
You Have Questions; Wormington & Bollinger Has Answers
If you have questions about legal rights for yourself or a loved one, then our team at Wormington & Bollinger is always here to help. We have years of experience with healthcare-related legal cases, and we offer full-service solutions for patients who have been harmed by the medical industry.
For more information, we invite you to schedule a consultation so that our legal team can review your case and explain your legal rights. The healthcare industry can be complicated, which is why you need a trusted legal team to advocate on your behalf.
Contact us at Wormington & Bollinger as soon as possible for a free, no-obligation consultation. We work on a contingency basis, which means that you don’t have to pay anything out of pocket because we are paid when you receive a settlement.