All Fraud Must Come to an End

65746451 - profession, people, healthcare, medicare and medicine concept - close up of happy medics or doctors pointing finger at hospital corridor

Hospice services are for people who are facing a terminal illness. A team of doctors, nurses, hospice aides, counselors and volunteers usually work together to provide the best quality of life possible for those facing the end of their lives. Today’s ”Fraud of the Day” tells about a woman who used her hospice company to bilk more than $7.5 million from federal and state health care benefit programs through her so-called ”terminal” patients. (Her patients were actually doing quite well.)

The article details that the California hospice care company owner, her daughter and four co-conspirators were involved in submitting more than $9 million in fraudulent bills to Medicare and Medi-Cal, California’s Medicaid welfare program. Over four years, the two government benefits programs paid out more than $7.5 million for the fraudulent claims.

The scheme involved the owner and her daughter paying recruiters to refer Medicare and Medi-Cal beneficiaries to the hospice company. Registered nurses would conduct assessments to determine the extent of the patients’ illnesses and two doctors would certify that they were terminally ill, when in fact, the majority were not. Furthermore, company personnel altered the patient medical records to make beneficiaries appear more ill than they actually were.

One interesting tidbit about this case is that the hospice company owner actually purchased her company while under investigation for her involvement in a separate health care fraud scheme. Incidentally, she ended up serving four-and-a-half years in prison for the previous offense. (History does have a way of repeating itself.)

The 70-year-old owner was sentenced to eight years in federal prison for her illegal acts. Her daughter pleaded guilty to one count of felony health care fraud and is awaiting sentencing.

This septuagenarian has sealed the fate of her company and the justice system has ended her second health care scam. She will be close to 80 years old when she gets out of prison, barring the discovery of any more health care schemes. (One thing is for sure – prison is probably not going to give her the quality of life she was expecting for her golden years.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Medicare millionaire fraud: 8 years in prison as ‘dying’ patients were just fine,” posted on on June 20, 2016.

A 70-year-old Placentia woman was sentenced Monday to eight years in federal prison for running a hospice that submitted millions of dollars in fraudulent bills to Medicare and Medi-Cal for end-of-life care for patients who were, in reality, not dying.

Priscilla Villabroza — who recently completed a 4 1/2-year term at a federal prison in Victorville for running a separate fraud scheme — pleaded guilty in December to a felony health care fraud count before U.S. District Judge S. James Otero.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.