California is the Golden State for Fraud; 18% of All the Country's "Home Health Care" Billing Comes from LA

Almost 20% of the country's welfare funds for "home health care" goes to 440 square miles in California.

And LA is scamming the country for billions for fake Medicare services.

Los Angeles hospice fraud reaches billions as Medicare providers scam federal system with fake companies Medicare chief says fraudulent providers scam taxpayers with ghost patients and sham companies in scheme involving corrupt doctors

Ghost patients, sham companies, offshore owners and corrupt doctors. Auditors and prosecutors say hospice fraud in Los Angeles is off the charts, with providers scamming billions from taxpayers for patients that don't exist, poor care and no care.

"Hospice is crazy here," says Dr. Mehmet Oz, head of the Centers for Medicare and Medicaid Services.

"You've got hospice that's grown seven-fold in the last five years. They represent about three and a half billion dollars of fraud, we believe, just in LA County."

Backing him up was California Attorney General Rob Bonta, who said last year, "Hospice fraud has become an epidemic in California, specifically in the greater Los Angeles area."

Bonta says fraudulent providers submit false claims for unnecessary services, and recruiters get kickbacks for signing up seniors, whether they're sick or not. Hospices also enroll patients who don't even know they've been scammed until they seek out medical care.

"As a hospice owner, I could sign up everybody in this room for hospice," an LA hospice owner told us.

A whistleblower told us there's no limit on the number of hospices an individual can own, and applicants can live abroad.

"It's all just paperwork. I could fill [an application] out in Kazakhstan if I want, and get a hospice license."

He explained how the scam works:

Recruiters go to shopping centers and senior centers to sign up patients, promising them walkers, a month's supply of nutritional drinks, cash and weekly visits in exchange for a Medicare number.

Recruiters then sell that "benny" or beneficiary's Medicare number to a provider for a $1,000 to $3,000 and receive a cut for every month the senior stays on their rolls.

Hospice enrollees are supposed to have a terminal illness or life expectancy of six months or less. But frequently hospice owners treat patients like trading cards, moving them from one provider to another if they stay too long, which raises a red flag with auditors.

In the U.S., more than 50% of hospice patients die within 18 days or less. In LA, the average length of stay is more than three months, and, in many hospices, patients never die, with court records showing hospices billing the federal government for 18 months and more.

In LA, a hospice is paid by the federal government $260 a day for each day a senior is under its care.

...

"A Medicare MIB number is more lucrative than a credit card," says Sheila Clark, president of the California Hospice and Palliative Care Association, referring to the 11 character code each Medicare recipient has that allows federal reimbursement. "They're human traffickers. They're trafficking beneficiaries in and out of hospices, home health."

At City Journal, a Democrat whistleblower in Minnesota affirms that the fraud is real and spectacular.

The Minnesota Department of Human Services is the state agency responsible for overseeing the programs at the heart of the scandal. Faye Bernstein has been a DHS employee for two decades, including stints working in contract management and as a compliance officer.

During the early years of Governor Tim Walz's administration, Bernstein says that she began raising concerns internally at DHS about concerning practices that exposed tax dollars to fraud. In response, Bernstein claims that her DHS supervisors retaliated against her.

In a recent interview with City Journal, Bernstein painted a picture of a toxic workplace culture at DHS that allowed Minnesota's fraud scandal to metastasize. This interview has been edited for clarity and length.

City Journal: When did your concerns about fraud begin?

Faye Bernstein: In 2018 and 2019. I had just gotten a promotion to a lead position. That meant I saw everybody's contracts from our work area [Behavioral Health Administration]. They all funneled through me. Over the years, I had often thought that DHS is sloppy. But 2018 and 2019 are when I saw, oh gosh, this is beyond normal. If we don't have fraud today, we're going to have fraud soon.

CJ: Can you give an example?

FB: I could give a contract to my sister for a million dollars because she has a different last name, pay out that contract, and nobody would notice. We did not monitor conflict of interest. It would have been easy to give a contract to a family member or to a nonexistent person. That's when I realized, this sloppiness is way beyond normal. We really are at risk of fraud.

CJ: Can you give other examples of things you saw?

FB: The reason I can confidently say that I could give a contract of this sort to my sister was because I had come across a contract that DHS had given to a former employee who had left the department within the past year. I immediately recognized her name, so I went to the person who initiated that contract and said, "What's the deal with this? I want to make sure everything's okay, that we don't have a conflict."

The person immediately went to our deputy director, who then came to me and said, "Why are you asking these questions?"

And I said, "Well, gosh, this is just a perfectly normal question."

"No, it's not. You're upsetting people. You've just made a lot of enemies by asking these questions."

It made no sense to me. We were constantly getting into risky territory. And if you spoke about it, it was very clear what would happen. Even our human resources people would tell us, "If your supervisor tells you to do something, you must do it." And when you didn't, the word "insubordination" came up. They considered it insubordinate if you resisted an unlawful direction.

CJ: Did this culture at DHS help facilitate fraud?

FB: It definitely did. Where we are today is completely predictable from where we were in 2019. There was no other way for this to go. The handwriting was on the wall. Until only about a year ago, our whistleblower policy required us to report internally; that did not comply with the law. The only reason [DHS had that policy] was so that they could find out who was reporting.

posted by Ace at 04:30 PM

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