FBI Busts Major Medicare Fraud Scheme in California Hospice Industry

The FBI recently apprehended a couple for allegedly submitting fraudulent Medicare claims totaling $7.45 million through their hospice operation, distinguished by a remarkably high survival rate. This arrest initiates a series of planned legal actions. In typical hospice care, individuals have terminal conditions, making a high survival rate an unusual and suspicious indicator.

Gladwin and Amelou Gill, owners of 626 Hospice operating under the name St. Francis Palliative Care, were detained during an FBI raid in San Dimas, California. This federal law enforcement action was supported by Dr. Mehmet Oz, the federal official overseeing Medicare, highlighting the collaborative effort in tackling fraud.

Hospice fraud poses a significant regulatory challenge in California, actively addressed by state and federal officials. Bill Essayli, United States Attorney for the Central District of California, emphasized the importance of these legal actions and confirmed multiple defendants' involvement in hospice fraud. Alarmingly, a network of fraudsters was reportedly orchestrating activities from prison.

A comprehensive investigation by CBS News uncovered numerous signs of potential fraud among hospices in Los Angeles County. Indicators such as low patient numbers and unwarranted billing practices were prevalent, with multiple hospices operating from single locations raising further concerns of fraudulent activities.

The Department of Health and Human Services' Office of Inspector General has identified hospice fraud as a nationwide issue, citing significant financial losses. Recent congressional inquiries have underscored these challenges, emphasizing the need for greater oversight and regulatory compliance to combat fraudulent practices in California.

California Attorney General Rob Bonta has initiated numerous criminal and civil actions against those perpetrating fraud within the hospice industry. Despite these efforts, Bonta acknowledges the difficulty in addressing fraud before substantial financial damage occurs. A temporary halt on new hospice licenses has been extended, aiming to strengthen regulatory measures and address public concerns.

Bonta assures the public of ongoing efforts through task forces dedicated to combating hospice fraud. This collaborative effort among various agencies is designed to prevent future incidents and hold offenders accountable, aiming to mitigate the prevalence of hospice fraud in California.