Terminally Fraudulent

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37187530 - medical team examining patient in hospital.

Receiving a terminal illness diagnosis can be devastating to the person receiving the news as well as their family members and friends. Thankfully, hospice care exists to help address the fears and face end-of-life issues. A former Anaheim, California doctor committed Medicare fraud by declaring many of his patients as terminal and in need of medically unnecessary treatments under hospice care. It turns out that he was just a cog in a larger wheel of fraud involving a California hospice company owner and her daughter.

The hospice company in today’s fraud article submitted roughly $8.8 million in fraudulent bills to Medicare and Medi-Cal, California’s Medicaid program, for end-of-life services over about four years. A number of employees at the company participated in the scheme, including today’s fraudster, a former doctor.

Evidence presented at the doctor’s two-week trial showed that he recruited patients for the fraudulent scheme and received tens of thousands of dollars in kickbacks from the hospice company. (He not only referred the Medicare beneficiaries, but also made fraudulent diagnoses and falsely certified that these patients were terminally ill so he could order medically unnecessary treatments.) Many of the purportedly terminal patients testified at the trial that they did not need end-of-life hospice care. (I’m glad they were able to cheat death and catch a fraudster all at the same time.)

Other co-conspirators included registered nurses, who performed assessments to determine if the beneficiary was terminally ill. Today’s fraudster and one other doctor certified that the government healthcare beneficiaries were dying, even though they were not terminally ill. (Medical records were then altered by other personnel at the hospice company in response to Medicare audits to make the hospice patients appear more ill than they were.)

At the top of the scheme was the hospice company owner and her daughter, who made the fraud wheel go around. (The daughter paid patient recruiters to bring Medicare and Medi-Cal beneficiaries to the hospice owned by her mother.)

The 62-year-old doctor at the center of today’s article was sentenced to nine years in prison for falsifying Medicare patient records to indicate they were terminal and needed hospice care. He was also ordered to pay around $3.3 million in restitution and the California Medical Board revoked his medical license. (This sentence was not the doctor’s first experience with fraud. He also faces sentencing for a separate healthcare fraud case.)

As for the other co-conspirators? They have all pleaded guilty including the other doctor, a 45-year-old man from Pasadena, who was sentenced to four years behind bars and ordered to pay $1.3 million in restitution. The 71-year-old hospice company owner and ringleader was sentenced to eight years in prison and she must pay more than $7 million in restitution. Her 46-year-old daughter is scheduled to be sentenced.

This scheme has not only victimized the patients, but also public healthcare programs and the taxpayers who fund them. The doctor in this case is fortunate to not have received a life sentence for what he did. The government effectively terminated this scam and put those responsible for it behind bars. (They won’t be going anywhere any time soon.)

Today’s “Fraud of the Day” is based on an article entitled, ‘Dying patients’ not dead yet: Ex-doc gets nine years for $3 million Medicare fraud,” posted on MyNewsLA.com on July 7, 2017.

A former doctor from Anaheim was sentenced Friday to nine years behind bars for falsely certifying that Medicare patients were terminally ill, and thus qualified for hospice care, when the vast majority of them were not actually dying.

Sri “Dr. J” Wijegoonaratna, 62, was also ordered to pay about $3.3 million in restitution to the federal government, according to the U.S. Attorney’s Office.

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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.