California Hospice Fraud Investigation: Authorities Probe Large-Scale ScamMillions of taxpayer dollars have allegedly been lost to fraudulent hospice companies.
In California, Congress is currently investigating a significant number of hospice programs that may have committed widespread Medicare fraud, including overbilling and enrolling vulnerable patients without their knowledge. According to […]
In California, Congress is currently investigating a significant number of hospice programs that may have committed widespread Medicare fraud, including overbilling and enrolling vulnerable patients without their knowledge. According to a CBS investigation by Laura Geller, Adam Yamaguchi and Rachel Gold, more than 700 of LA County’s hospices triggered red flags for state-defined fraud. According to the article, “suspected hospice fraud totaled an estimated $198.1 million” and is an “acute issue.”
Michael Connors of the California Advocates for Nursing Home Reform told the Los Angeles Times that “there’s no quick fix for this scandal. California gave out hundreds of licenses to hospice operators who are in the business for all the wrong reasons.”
The Types of Hospice Fraud
Overbilling is one of the main types of fraud allegedly committed by certain hospice programs, which involves medical facilities billing Medicare for excessive amounts, including procedures that did not occur. Nearly all hospices in LA county who submitted data to Medicare billed above the national average, according to the CBS investigation.
Other instances of alleged hospice fraud include patients staying for a longer period of time than average hospice patients and being discharged while still alive, according to the LA Times. Hospice care involves palliative care for terminally ill patients; investigations found recruiters were signing up patients for hospice under the false promise of receiving medical care, housekeeping help, or medical equipment. In some cases, patients “later learned they had forfeited their rights to lifesaving emergency medical treatment.”
CBS interviewed a particular Medicare patient, Lynn Ianni, who upon receiving a denial for physical therapy, discovered her Medicare number had been stolen and fraudulently enrolled in hospice without her knowledge. “‘Are you kidding me?” the avid pickleball player remarked. “Do I look like I’m in hospice?’”
CBS News also launched an investigation into a so-called “ground zero” of hospice fraud in Los Angeles County, where almost 100 hospice companies co-exist in one commercial building. This practice, a pattern referred to as “geographic clustering,” is a key sign of fraud in the industry. “Nearly 40 companies in the CBS News analysis, for instance, share key personnel.” Since the companies all have valid licensing, the building owner’s hands are tied.
California Congress Investigation
California House Republicans, through the House Oversight Committee, have submitted a letter to California Governor Gavin Newsom to investigate and acquire documents relating to this Medicare hospice fraud dating from 2019 to April 2026.
“The Committee is concerned your administration does not have sufficient internal controls to prevent and detect fraud and is not conducting proper oversight of these hospice programs,” the letter says. “As a result, Americans across the country are paying for California’s rampant hospice fraud and vulnerable patients are being exploited.”
While the California government has issued a moratorium, or temporary suspension, on new hospice licensing through January 2027, the state missed recent deadlines to enact emergency regulations for hospice services. Public health officials are creating new regulations to vet new hospice licensing applicants and hold existing companies accountable.
The California government has since developed a hospice fraud task force to address the issue, resulting in 280 hospice licenses being revoked over the past two years, with an additional 300 providers under investigation.
Conclusion
California is not the only state under investigation for Medicare and hospice fraud. The current administrator of the Centers for Medicare and Medicaid Services, Dr. Mehmet Oz, has requested documentation from Florida Governor Ron DeSantis regarding Medicare fraud. The House Oversight Committee is also investigating alleged fraud surrounding social service programs in Minnesota.
Medicare and hospice fraud continues to be a rampant problem in California and everywhere. From patients being enrolled in hospice without their knowledge to the overbilling of Medicare for vulnerable patients on hospice, these audits and investigations paint quite a disturbing picture of a systemic problem that needs far more attention.
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