Literature Review

Amid huge growth in Southern Nevada’s hospice industry, lawmaker pushes for more oversight The Nevada Independent; by Tabitha Mueller; 3/5/25 The number of licensed hospice providers in Southern Nevada jumped by more than 350 percent since 2020 — a proliferation combined with minimal industry regulation that health care experts warn harms patients and leads to fraud. To address the issue, Assm. Rebecca Edgeworth (R-Las Vegas) is sponsoring AB161, which is scheduled for a hearing Wednesday. The measure, Edgeworth said, is a way to “raise the bar” for hospice providers and protect patients. “In the last few years, there has been this horrendous influx of charlatans and flimflam artists,” Edgeworth told The Nevada Independent.

Hospice Insights Podcast - Controlling the narrative: A new tactic for auditors and ALJs JD Supra; by Bryan Nowicki and Meg Pekarske; 2/19/25 Hospices that have gone through audits are familiar with certain recurring reasons why auditors deny claims. Two common reasons are the lack of support for a six-month prognosis and the insufficiency of the physician narrative. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss a new twist on these kinds of denials, and how hospices can strengthen their documentation to try to avoid them.

Saad Healthcare agrees to pay $3M to settle False Claims Act allegations that it billed Medicare for ineligible hospice patientsU.S. Department of Justice - Office of Public Affairs; Press Release; 2/21/25Saad Enterprises Inc., doing business as Saad Healthcare, has agreed to pay $3 million to resolve allegations that it violated the False Claims Act by knowingly submitting false claims for the care of hospice patients in Alabama who were ineligible for the Medicare hospice benefit because they were not terminally ill. ... The settlement resolves allegations that between 2013 and 2020 Saad submitted, or caused the submission of, false claims to Medicare for 21 patients who did not meet the eligibility requirements for the Medicare hospice benefit as defined by statute and regulation, despite Saad knowing the patients were ineligible for the Medicare hospice benefit.

UnitedHealth drops dismissal bid in US suit over Amedisys deal Bloomberg Law; by Justin Wise; 2/6/25 (additional subscription may be required)UnitedHealth Group Inc. is withdrawing its motion to dismiss the Justice Department’s lawsuit seeking to block its $3.3 billion acquisition of home-health and hospice services provider Amedisys Inc. and planning to fight the case at trial. In a Wednesday [2/5/25] filing in the US District Court for the District of Maryland, UnitedHealth and Amedisys said that new information provided by the Justice Department eliminated the basis for its request to toss the case at a preliminary stage. The firms previously argued the DOJ was withholding key geographic market information integral to its claim that the tie-up would stifle competition ...

Man pleads guilty in connection with $17m Medicare hospice fraud and home health care fraud schemes Office of Public Affairs - U.S. Department of Justice; Press Release; 2/3/25A California man pleaded guilty today to health care fraud, aggravated identity theft, and money laundering in connection with a years-long scheme to defraud Medicare of more than $17 million through sham hospice companies and his home health care company. According to court documents, Petros Fichidzhyan, 43, of Granada Hills, engaged in a scheme with others to operate a series of sham hospice companies. Fichidzhyan, along with co-schemers, impersonated the identities of foreign nationals to use as the purported owners of the hospices — including using the identities to open bank accounts and sign property leases — and submitted false and fraudulent claims to Medicare for hospice services that were not medically necessary and not provided. In submitting the false claims, Fichidzhyan and his co-schemers also misappropriated the identifying information of doctors ... [Click on the title's link to continue reading.]

Home health operator sentenced to 12 years in prison for $100M fraud schemeHome Health Care News; by Audrie Martin; 1/27/25A Westford, Massachusetts woman was sentenced to 12 years in prison after being convicted of a $100 million home health care fraud. Faith Newton, former operator of Chelmsford, Massachusetts-based Arbor Homecare Services LLC, was sentenced in federal court to 12 years in prison to be followed by three years of supervised release. She was also ordered to pay a fine of $250,000 and restitution of more than $99.7 million. In July 2024, Newton was convicted of one count of conspiracy to commit health care fraud, one count of health care fraud and three counts of money laundering. The jury found the defendant not guilty on one count of money laundering conspiracy. Newton was arrested and charged along with co-defendant Winnie Waruru in February 2021.

U.S. Attorney’s Office recovers more than $55 million in civil settlements and judgments in calendar year 2024United States Attorney's Office - Western District of Texas, San Antonio, TX; 1/28/25U.S. Attorney Jaime Esparza announced today that the Western District of Texas recovered $55,969,678.60 in settlements and judgments in over 25 affirmative civil enforcement cases between January 1, 2024, and December 31, 2024. ... The office’s largest civil recoveries were obtained in False Claims Act (FCA) matters. The most significant FCA recoveries include: ...

Operator of home health care company sentenced to 12 years in prison for multimillion dollar health care fraud schemeDOJ press release; 1/23/25[Massachusetts] Faith Newton, 56, was sentenced... to 12 years in prison to be followed by three years of supervised release. Newton was also ordered to pay a fine of $250,000 and restitution in the amount of $99,734,517. In July 2024, Newton was convicted of one count of conspiracy to commit health care fraud, one count of health care fraud and three counts of money laundering. The jury found the defendant not guilty on one count of money laundering conspiracy... “Ms. Newton used the home health care agency she operated to perpetrate a massive, years-long fraud scheme that siphoned over $100 million from a program designed to support our most vulnerable residents."

NPHI supports lawsuit to ensure proper implementation of Hospice Special Focus Program National Partnership for Healthcare and Hospice Innovation, Washington, DC; Press Release; 1/16/25Today, a lawsuit was filed by the Texas Association for Home Care & Hospice; Indiana Association for Home & Hospice Care; Association for Home & Hospice Care of North Carolina; South Carolina Home Care & Hospice Association; and Houston Hospice. The lawsuit challenges CMS’s implementation of the hospice Special Focus Program (SFP) as unlawful and arbitrary. We acknowledge that Houston Hospice, an NPHI member, is one of the plaintiffs in this legal action, and we are committed to supporting them and others impacted by the SFP or the accompanying excel files. The hospice Special Focus Program (SFP), conceived and passed on a bipartisan basis as a part of the HOSPICE Act in 2021, was designed to address poor-quality hospice providers by offering them additional support and technical assistance to ensure compliance with the Medicare Hospice Conditions of Participation. NPHI is extremely disappointed that CMS has departed from that Congressional intent, transforming the hospice SFP into a burden for many well-meaning hospices, with an algorithm for identifying providers based on inaccurate data and including elements that are not referenced in the statutory language. ... NPHI fully supports the litigation filed today, which aims to direct CMS to comply with the spirit and intent of the statute and regulations. [Click on the title's link to continue reading.]

Santa Maria investment advisor pleads guilty to federal wire fraud chargeSannta Maria Times, Santa Maria, CA; by Dave Minsky; 1/2/25 A Santa Maria registered investment advisor pleaded guilty to a wire fraud charge after admitting to stealing $2.25 million from mostly elderly clients who put her in charge of their assets, according to a plea agreement filed in Los Angeles federal court earlier this month. ... Federal officials alleged that [Julie] Darrah’s scheme ran from November 2016 until about July 2023 and involved at least 11 victims who were mostly elderly, including some who were receiving end-of-life care. ... Prosecutors alleged Darrah would gain control of her clients’ assets in several ways, including making her the trustee of their trusts, having the victims executing standing letters of authorization that gave Darrah control of their accounts, making Darrah a signatory on their accounts and giving Darrah power of attorney over their property.

Santa Paula doctor sentenced to 2 years in federal prison for role in hospice fraud that bilked Medicare out of $3.2 million United States Attorney's Office - Central District of California; Press Release, Los Angeles, CA; 12/16/24 A Ventura County physician who worked for two Pasadena hospices was sentenced today to 24 months in federal prison for defrauding Medicare out of more than $3 million through claims for medically unnecessary hospice services. Dr. Victor Contreras, 69, of Santa Paula, was sentenced today by United States District Judge André Birotte Jr., who also ordered him to pay $3,289,889 in restitution. Contreras pleaded guilty on July 24 to one count of health care fraud. From July 2016 to February 2019, Contreras and co-defendant Juanita Antenor, 62, formerly of Pasadena, schemed to defraud Medicare by submitting nearly $4 million in false and fraudulent claims for hospice services submitted by two hospice companies: Arcadia Hospice Provider Inc., and Saint Mariam Hospice Inc. Antenor controlled both companies. Editor's note: This press release follows-up on the post we recently posted: Glendale woman and Lakewood man found guilty of $3.2 million hospice fraud scheme involving kickbacks for patient referrals. 

Glendale woman and Lakewood man found guilty of $3.2 million hospice fraud scheme involving kickbacks for patient referrals United States Attorney's Office - Central District of California, Los Angeles, CA; Press Release; 12/12/24A Glendale woman and a Lakewood man have been found guilty by a jury of paying and receiving hundreds of thousands of dollars in illegal kickbacks for patient referrals that resulted in the submission of approximately $3.2 million in fraudulent claims to Medicare for purported hospice care, the Justice Department announced today. Nita Palma, 75, of Glendale, was found guilty late Wednesday of 12 counts of health care fraud and 16 counts of paying illegal kickbacks for health care referrals. Percy Abrams, 74, of Lakewood, also was found guilty late Wednesday of six counts of receiving illegal kickbacks for health care referrals. ... Consistent with instructions provided by Palma, Abrams falsely represented to prospective patients that they did not need to be dying to be on hospice. After collecting personal identifying information from prospective patients that were not dying, Abrams sent the information to Nita Palma so she could bill Medicare for purported hospice care.Editor's note: Caution. How many hospices have misused information about President Jimmy Carter's long Length of Stay (LOS) to purport similar messaging that "hospice is not about dying"? Too often, articles we would review used "not about dying" language and never mentioned anything about ongoing clinical review for hospice appropriateness, 6-month Face to Face visits, et al.