Hospice providers are recruiting seniors in Ventura County and across Southern California who aren’t terminally ill and promising care and equipment that is not delivered, federal investigators and a care leader said.
The rising level of fraud is reflected in the at least six hospice programs in the county that reported 100% live discharge rates in Ventura County last year, said nonprofit hospice CEO Molly Corbett, providing data from the U.S. Centers of Medicare and Medicaid Services.
It meant no one died in Medicare-funded hospice programs designed for people who are dying.
“Every person they brought into care was discharged alive,” she said.
Corbett, leader of the Livingston Memorial Visiting Nurse Association hospice and home care nonprofit,
has emerged as a point person on fraud. She and federal fraud investigators delivered presentations to hospice providers, home care workers and other members of the Ventura County Homecare Association on Aug. 19.
She said changes in federal payment for hospice triggered a gold rush of new providers. The 29 Ventura County providers with 11 or more patients in 2016 has grown to at least 79.
Many of the hospices rely heavily on assisted living centers for patients, she said, noting the trend can mean seniors who may or may not be terminally ill are being funneled into the same programs without being given a choice.
The fraud has brought federal and state moratoriums on new providers and a surge of actions with California suspending nearly 300 hospice licenses in the last two years.
Special Agent Alison Davis of the U.S. Department of Health & Human Services said some hospices illegally pay money or provide other kickbacks to people or companies that provide referrals to possible patients.
Davis, who investigates fraud in a region that includes Ventura County, said some providers sign up people who don’t qualify and fabricate their conditions. Sometimes, the people recruited have no idea they’re being signed up for hospice.
Providers often recruit the poor and people who don’t speak English, Davis said. When people sign up for hospice, they no longer receive care designed to treat illnesses purported to be terminal, certain prescriptions and other services.
“These people don’t get the care they actually need,” Davis said.
Corbett said the fraud means some organizations enroll so many people that they can’t, or just don’t, provide services. She said her organization gets calls from families who have signed up for hospice and haven’t seen nurses or received needed medical supplies.
Some providers from outside of the county come to the region seeking patients, she said. Los Angeles County has emerged as a center of fraud, she said, noting Ventura County’s proximity has gained the attention of investigators.
"They're looking at Ventura, Orange and the surrounding counties around Los Angeles," she said.
Davis said she’s worked several cases in Oxnard and noted the community is a hotspot for alleged Medicare fraud.
Federal authorities in Los Angeles announced in Aprileight people had been arrested for alleged Medicare fraud involving hospice, including the CEO of a Simi Valley provider.
Corbett said people shopping for hospice should interview more than one provider and should look providers up on the Medicare compare site. She also suggested the following questions:
- Is this provider accredited by Medicare?
- How quickly do hospice nurses respond?
- Is there a written plan of care?
- How often will someone visit?
- Can people change agencies if they’re not satisfied?
She told providers the fraud has sown doubt about hospice. She urged other providers to report violations when they see them in or outside of their organizations.
“It is our responsibility as part of the industry to stop it,” she said.
Tom Kisken covers health care and other news for the Ventura County Star. Reach him at tom.kisken@vcstar.com.
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This article originally appeared on Ventura County Star: Surge of hospice fraud hits Ventura County, experts warn
