Fil-Am accused of enrolling non-terminal seniors in Medicare hospice scheme

NEW YORK — A 60-year-old Filipino American from Los Angeles has been charged with healthcare fraud for allegedly operating a hospice scheme that billed Medicare approximately $9.8 million for services that were medically unnecessary or never provided.

According to the criminal complaint, the respondent allegedly used a Southern California-based hospice agency to enroll Medicare beneficiaries in hospice care even though they were not terminally ill. Medicare paid more than $8.3 million for those claims.

Seniors recruited

The complaint alleges that the respondent and his marketers recruited seniors at community centers by offering free medical services and, in many cases, illegal payments or kickbacks as incentives.

He allegedly avoided using the word "hospice," instead describing the care offered as "palliative services." He also allegedly photographed beneficiaries' identification documents and completed their paperwork without them present.

According to accounts cited in the complaint, beneficiaries said they had never been diagnosed with the terminal conditions listed in their claims. They also reportedly received little or no care, even though Medicare was billed for dozens of visits.

Some allegedly learned that they had been enrolled in hospice only after Medicare or their primary care doctors contacted them.

Discharged patients

The hospice agency had an estimated non-death discharge rate of 85%, referring to the proportion of patients discharged from hospice for reasons other than death.

According to the complaint, that rate was more than four times the national average, suggesting that the beneficiaries enrolled were not terminally ill.

The complaint also alleges that the accused controlled more than a dozen other hospice entities that collectively submitted over $107 million in similarly fraudulent claims. Many had non-death discharge rates exceeding 75%, while some exceeded 90%.

Fraud proceeds

According to bank records cited in the complaint, the respondent allegedly received more than $444,000 in direct transfers. Hundreds of thousands of additional dollars were allegedly sent to family members, associates and marketers.

Some of the alleged fraud proceeds were also used to pay for vehicles purchased or financed in a beneficiary's name without that person's consent.

The Filipino American is among 15 defendants charged in a US Department of Justice health care fraud takedown involving the department's newly established fraud division, which focuses on investigating and prosecuting those who defraud the American people. — VDV, GMA News