Los Angeles County Hospice Industry Under Scrutiny for Suspected Medicare Fraud

- 18% of THE WHOLE COUNTRY'S home health care billing is coming out of Los Angeles County

- One doctor billed the government $120 million in a single year claiming to oversee 1,900 patients

Los Angeles County has drawn significant attention from federal officials due to concerns over potential fraud in the Medicare hospice and home health care sectors. Recent reports indicate that the county accounts for approximately 18% of the nation's total Medicare billing for these services, despite representing only about 2.5% of the U.S. population.

According to statements from CMS Administrator Dr. Mehmet Oz, the region has experienced a seven-fold increase in hospice billing activity over the past five years. Oz has estimated that fraudulent activity in Los Angeles County hospice and home health care could amount to roughly $3.5 billion annually. Federal data shows the county hosts nearly 1,923 hospice providers, a number that exceeds the total in many other states combined.

Investigations have highlighted patterns such as excessive geographic clustering of providers, with multiple agencies sometimes operating from the same address. Examples include reports of dozens or even over 100 hospices listed at single locations, often in commercial areas like strip malls or office buildings. Federal and state authorities have identified cases involving sham operations that bill Medicare for services not provided, enrollment of ineligible patients, and other irregularities.

In response, California implemented a moratorium on new hospice licenses starting in 2022, which has been extended through January 1, 2027. Since the moratorium began, the state has revoked more than 280 hospice licenses. California Attorney General Rob Bonta has described hospice fraud as an epidemic in the greater Los Angeles area, with ongoing prosecutions resulting in criminal charges, civil cases, and prison sentences for individuals involved in multimillion-dollar schemes.

Federal efforts have also intensified. CMS has referred cases to law enforcement, and congressional leaders from key committees have requested briefings from the HHS Office of Inspector General on the scope of the issue and actions being taken. Recent enforcement actions have included convictions and guilty pleas in schemes defrauding Medicare of tens of millions through fraudulent hospice billing.

These developments raise concerns about the integrity of Medicare funding and the potential impact on vulnerable patients, who may receive unnecessary or substandard care while legitimate providers face challenges. Federal and state officials continue to prioritize oversight and enforcement to address suspected fraud in the hospice industry.

Chet McSnark is the Santa Monica Observer's reporter covering health care policy and government accountability.