Hospice Heist

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The National Hospice and Palliative Care Organization reports that Medicare paid $16.7 billion for 1.43 million beneficiaries in hospice care during 2016. A decade earlier, Medicare’s costs for hospice care totaled $9.2 billion for less than 1 million beneficiaries. You’re about to take a look at a former physician from Southern California and his business partner who concocted a Medicare fraud scheme that contributed to the $7.4 billion rise in costs over 10 years.

The former physician from San Dimas and his business partner from Glendora operated their hospice heist scheme for more than five years, targeting hospice patients. (But, it’s important to share that the scam profiled in today’s fraud article was not this deceptive duo’s first run-in with the law.) These two men were previously convicted for defrauding California’s insurance system through a different business involving a residential care facility for disabled adults.

Now, back to today’s case. The two scammers from California filed falsified enrollment documents with Medicare to enable the former physician to operate home care and hospice agencies through other people. (Despite his prior conviction and ban from providing services to any federal healthcare program.) They also filed fake hospice care claims for people who were not terminally ill or in need of hospice care. In all, the two collected $7.1 million from the Medicare program. (Those funds should have been reserved for beneficiaries who truly needed them.)

The 76-year-old former physician and his 63-year-old business partner each pleaded guilty to Medicare fraud and money laundering. They both received a 33-month prison sentence for running their scheme at three hospice and home healthcare agencies located in Las Vegas. The two criminals will also serve three years of supervised release and be required to make full restitution to the Medicare program.

Hospice care is intended for patients who are chronically or terminally ill, not unethical medical providers who want to fund luxury vacations, bigger houses and shopping sprees. The medical provider was approved by the Medicare program to assist dying patients with dignity and compassion. What they did was greedy and disrespectful to those who deserve to receive palliative care at the end of their life. (One thing’s for sure — there won’t be anyone around to hold their hand or comfort them while they serve out their time in prison.)

Today’s “Fraud of the Day” is based on an article, “Former San Dimas doctor and associate sentenced in $7 million Medicare fraud scheme,” published by San Gabriel Valley Tribune on April 18, 2019.  

A former physician and his business partner — both from Southern California — were each sentenced to 33 months in prison for their roles in a $7.1 million Medicare health care fraud scheme at three Las Vegas hospice and home health care agencies, the U.S. Department of Justice announced Thursday.

The former doctor, Camilo Q. Primero, 76, of San Dimas, and Aurora S. Beltran, 63, of Glendora, also were sentenced Tuesday in Las Vegas to serve three years of supervised release after prison and ordered to pay restitution of about $2.4 million. The defendants agreed to make full restitution to the U.S. government.

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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.