Literature Review

Home health agency sues HHS over $34m Medicare payment recoupment Home Health Care News; by Morgan Gonzales; 9/8/25 Infinity Home Care of Lakeland, a Florida-based home health provider and affiliate of Amedisys, has sued the U.S. Department of Health and Human Services over Medicare recoupments. The Florida-based home health agency alleged that HHS completed “shoddy expert work” that led the agency to conclude that Medicare overpaid Infinity by $34 million for services from 2014 to 2016. According to the lawsuit, a contractor, Zone Program Integrity Contractors (ZPIC), reviewed 72 of the agency’s claims in 2017 and denied all 72 on the basis of errors with the face-to-face encounter documentation, that home health services were not medically reasonable and necessary or a lack of medical records. 

NMDOJ charges ‘imposter nurse’ who treated hospice patients in Albuquerque KRQE News, Albuquerque, NM; by Fallon Fischer; 8/28/25 A certified nurse assistant in Albuquerque is facing charges for allegedly stealing the identities of three nurses and illegally providing care to hospice patients, and in one case, almost causing one patient to die via a morphine overdose, according to the New Mexico Department of Justice. This week, a Bernalillo County grand jury issued an indictment against April Guadalupe Hernandez, 26, for 19 counts of misconduct including identity theft, nursing without a license, fraud totaling approximately $40,000, abuse of a resident, violations of the Nursing Practice Act and more. “To exploit trusting patients in their most vulnerable moments is unconscionable,” Attorney General Raúl Torrez stated in part, in a news release. 

New York indicts two under the state's new deed theft law; how to protect your home Consumer Affairs; by James R. Hood; 8/11/25 New York Attorney General Letitia James has announced the indictments of two people accused of orchestrating a brazen deed theft targeting an elderly widow in Kew Gardens Hills while she was receiving end-of-life hospice care in her home. Deepa Roy, 68, of Manhattan, and Victor Quimis, 39, of Queens, allegedly forged the signature of Mrs. Renuka Bherwani to unlawfully transfer ownership of her home — which she had owned for nearly four decades — first to themselves, then to Quimis’s company, Hunter Studios & Developer Corp. 

Hospitals accused of hiding deaths, storing bodies for months, and not telling families Nurse.org; by Brandy Pinkerton, RN; 7/25/25 Families in the Sacramento area say they spent months, and in some cases years, desperately searching for loved ones who had vanished—only to discover that their remains had been left to decompose, unidentified and forgotten, in an off-site morgue operated by Dignity Health hospitals. Now, a series of lawsuits and regulatory audits allege that one of California’s largest healthcare systems demonstrated “callous, reckless, and outrageous failure” by neglecting to notify families of patient deaths, withholding death certificates, and consigning bodies to languish in storage, compounding the anguish of those left behind. 

Humana renews challenge to downgrade of US Medicare 'star' ratings Reuters; by Daniel Wiessner; 7/21/25 Humana ... filed a new lawsuit over the U.S. government's reduction in the health insurer's star ratings for government-backed Medicare plans, after an earlier challenge was dismissed on technical grounds. Humana, in the lawsuit in Fort Worth, Texas, federal court, says the lower ratings could cause it to lose customers and potentially billions of dollars in bonus payments from the government, which would have been used to reduce premiums and increase benefits for its members. U.S. District Judge Reed O'Connor in Fort Worth dismissed those claims last week, finding Humana had failed to exhaust all of its out-of-court options to challenge the ratings. In the new lawsuit, Humana says it has in recent months exhausted an administrative appeals process, giving the insurer standing to sue. 

20 states sue after the Trump administration releases private Medicaid data to deportation officials Associated Press (AP), Washington, DC; by Amanda Seitz and Kimberly Kindy; 7/1/25The Trump administration violated federal privacy laws when it turned over Medicaid data on millions of enrollees to deportation officials last month, California Attorney General Rob Bonta alleged on Tuesday, saying he and 19 other states’ attorneys general have sued over the move. Health secretary Robert F. Kennedy Jr.’s advisers ordered the release of a dataset that includes the private health information of people living in California, Illinois, Washington state, and Washington, D.C., to the Department of Homeland Security, The Associated Press first reported last month. All of those states allow non-U.S. citizens to enroll in Medicaid programs that pay for their expenses using only state taxpayer dollars.

2 West Covina women arrested for alleged $4.8 million hospice care fraud CBS News KCAL, Los Angeles, CA; by Julie Sharp; 6/3/25 The U.S. Department of Justice announced that two West Covina women were arrested Tuesday for an alleged scheme to defraud Medicare of $4.8 million with false hospice care claims. One of the women who was arrested is the owner and operator of two West Covina hospices, Golden Meadows Hospice Inc., and D'Alexandria Hospice Inc., which billed Medicare for hospice services for patients who were allegedly not terminally ill.  Between Sept. 2018 and Oct. 2022, owner and operator Normita Sierra, 71, and her alleged accomplice, Rowena Elegado, 55, collected more than $3.8 million from Medicare on false claims, the DOJ said.

Assisted living facility where woman was fatally beaten operated out of 'pure greed:' Suit Delaware New Journal; by Isabel Hughes; 5/20/25 The family of an 83-year-old woman who was fatally beaten by another resident at The Summit assisted living in North Star has accused the facility and its parent company of "pure greed," claiming in a recently filed lawsuit that the previously violent assailant was not removed from the facility because he brought in nearly $400,000 for the company. The family of Shyuan Hsia who was attacked and left to suffer in her room for hours on the night of Aug. 5, 2024 filed the 84-page suit in New Castle County Superior Court in late April. ... Discovery Senior Living, the lawsuit says, "recklessly failed to remove" him, "because if they did so, they stood to lose approximately $370,000 in revenue." That number was derived from:

Santa Maria woman sentenced to 10+ years for stealing from elderly clients NBC KSBY-6, California's Central Coast; by KSBY Staff; 5/20/25 A former Santa Barbara County investment advisor was sentenced Monday to just over 10 years in federal prison for stealing millions of dollars from elderly clients of her investment advisory business in the Santa Maria area. Julie Darrah, 52, of Santa Maria, ran an investment advisory business called Vivid Financial Management Inc. (VFM). ... Prosecutors say she stole approximately $2.25 million from her clients between November 2016 and July 2023. ... In December 2024, a U.S. District judge found her liable to pay back her clients $2,416,511. Department of Justice (DOJ) officials say Darrah abused the trust her victims placed in her, accusing the defendant of manipulating her elderly clients into believing she would take care of them in their older years, like a daughter. Darrah would then use this trust to persuade her victims to sign documents giving her the ability to transfer funds from their bank accounts into other accounts, including her own. Some of her victims were reportedly left in desperate circumstances, without the money to pay for needed end-of-life care. ... Anyone who thinks they may be a victim of financial fraud can contact the National Elder Fraud Hotline at 1-833-FRAUD-11.

Walgreens will pay up to $350M in settlement with DOJ to resolve opioid prescription lawsuit Fierce Healthcare; by Heather Landi; 4/21/25 Walgreens has agreed to pay $300 million to settle allegations from federal prosecutors that it illegally filled millions of invalid prescriptions for opioids and other controlled substances, the Department of Justice (DOJ) announced Monday. The DOJ also alleges that the retail pharmacy chain sought payment for many of those "invalid" prescriptions by Medicare and other federal healthcare programs in violation of the False Claims Act. The settlement amount is based on Walgreens’s ability to pay, the DOJ said, but Walgreens will owe the U.S. an additional $50 million if the company is sold, merged or transferred prior to fiscal year 2032. 

DOJ’s lawsuit against Amedisys, UnitedHealth Group set for mediation Hospice News; by Jim Parker; 4/14/25 The U.S. Department of Justice’s (DOJ) lawsuit against Amedisys Inc. (NASDAQ: AMED) and UnitedHealth Group (NYSE: UNH) will go to mediation on Aug. 18. The DOJ sued the two companies starting in November of last year to block the UnitedHealth Group subsidiary Optum from acquiring Amedisys due to antitrust concerns. The case will now go to a mediation conference before a magistrate judge. ... DOJ’s chief concern is that the combination of the two companies would dampen competition in the hospice and home health space. Should the transaction proceed, Optum would control 30% or more of the home health or hospice services in eight states, according to the complaint. 

Ohio payer beats UnitedHealthcare in racketeering lawsuit, awarded $50M Becker's Payer Issues; by Jakob Emerson; 3/19/25 An Ohio jury awarded Medical Mutual of Ohio over $50 million in damages on March 12 after the payer prevailed in its lawsuit against FrontPath Health Coalition and HealthScope Benefits, a subsidiary of UnitedHealthcare. FrontPath offers employee benefits solutions, and HealthScope is a third-party administrator. .. The defendants were found to have committed federal wire fraud, telecommunications fraud, tampered with records, and obstructed justice by submitting false bid information. The jury found that the conspiracy resulted in significant damages to Medical Mutual and ultimately caused taxpayers to pay higher healthcare costs than necessary.

Lancaster woman convicted in hospice fraud schemeNBC-4 News, Los Angeles, CA; by City News Service; 3/21/25 A Lancaster [California] woman was found guilty Friday of receiving more than $330,000 in illegal kickbacks for patient referrals to two hospice companies in a fraud scheme that bilked Medicare out of more than $3.2 million through claims for medically unnecessary services. Callie Jean Black, 66, was convicted at the conclusion of a four-day bench trial in Los Angeles federal court of four counts of soliciting and receiving remunerations for patient referrals, according to the U.S. Attorney's Office. U.S. District Judge André Birotte Jr. scheduled sentencing for July 25. [Continue reading ...]