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, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.