Congress launches investigation into California hospice fraud

1 hour ago 4

House Republicans announced Monday that Congress volition equine an probe into "rampant hospice fraud," alleging that perchance tens of millions successful payer funds whitethorn person been mislaid successful improper payments to Southern California companies.

The Republican-led House Oversight Committee, which has the authorization to investigate, has sent a missive to California's Democratic governor, Gavin Newsom, asking for documents related to the state's "oversight and interior controls to observe and forestall fraud for its federally funded hospice programs."

"Recent reporting has revealed alarming grounds of fraudulent enactment successful California's hospice programs, including agencies overbilling Medicare and fraudulently enrolling beneficiaries without their knowledge," committee members wrote, citing a caller CBS News investigation.

The CBS News study examined concern and fiscal records of each hospice presently operating successful Los Angeles County, looking for the informing signs that a 2022 authorities audit identified arsenic potential indicators of fraud.

The CBS News investigation revealed that implicit 700 of the astir 1,800 hospices successful LA County triggered aggregate reddish flags for fraud arsenic defined by the state.

"The Committee is acrophobic your medication does not person capable interior controls to forestall and observe fraud and is not conducting due oversight of these hospice programs," the missive to Newsom states. "As a result, Americans crossed the state are paying for California's rampant hospice fraud and susceptible patients are being exploited."

A spokesperson for Newsom wrote successful a statement: "California took decisive enactment connected hospice fraud years ago. In 2021, Governor Gavin Newsom signed authorities placing a moratorium connected caller hospice licenses — a argumentation that remains successful effect today, preventing atrocious actors from entering the strategy portion strengthening oversight of existing providers."

Democrats said a determination by the Republican-controlled Congress to analyse whitethorn correspond an effort to divert attraction from different pressing challenges.

"Many voters are bombarded perpetually with these governmental shot games from Republicans," said Debbie Mucarsel-Powell, a erstwhile Democratic subordinate of Congress from Florida who present serves arsenic enforcement manager of George Washington University's Graduate School of Political Management.

"The world is that for astir Americans, the outgo of surviving continues to spell up, and they're not seeing immoderate benignant of alleviation from either enactment astatine this moment." she said.

Republican elected officials and an service of societal media influencers person seized connected the issue of fraud arsenic politically potent — accusing Democratic authorities executives of failing to forestall costly schemes, astir notably in Minnesota — wherever the Feeding Our Future pandemic alleviation scam outgo taxpayers hundreds of millions. Minnesota's Democratic governor, Tim Walz, announced successful January that helium would no longer question reelection amid fallout from that scandal.

The partisan quality of the California probe was evidenced connected the signature enactment of the House committee's missive — it is signed lone by Republican members.

House Oversight Committee Chairman James Comer

Hospice fraud remains a nationwide problem. Medicare is simply a taxpayer-funded wellness attraction programme for the aged and disabled that includes sum of hospice attraction for terminally sick patients. Americans wage into Medicare done taxes connected their paychecks and premiums. When there's Medicare fraud, it's taxation dollars that are being stolen.

The U.S. Department of Health and Human Services' Office of the Inspector General reported successful 2023 that suspected hospice fraud totaled an estimated $198.1 million. It has been an acute contented successful Southern California.

Nationwide, the mean magnitude a hospice bills Medicare per diligent is $13,200. CBS News recovered the emblematic hospice successful LA County billed Medicare astir $29,000 per diligent — much than treble the nationalist average. The highest complaint billed by a azygous hospice successful the region was $74,000 per patient.

Of the LA County hospices with disposable Medicare data, CBS News recovered astir each of them submitted bills supra the nationalist average.

The legislature missive seeks documents and communications betwixt the governor's bureau and respective authorities agencies, including the Department of Health Care Services, the Department of Public Health, the Department of Social Services and the California Department of Justice's Division of Medi-Cal Fraud and Elder Abuse. The missive requests accusation from Jan. 1, 2019 to today, with a deadline of April 6.

Though Medicare is federally administered, the authorities licenses hospices to beryllium capable to operate. A moratorium connected issuing caller hospice licenses successful the authorities was precocious extended done January 2027, due to the fact that the authorities missed its deadline to enact caller exigency regulations for hospices. Public wellness officials told CBS News they are balancing nationalist feedback to vet caller applicants and clasp hospices accountable.

A spokesperson for Newsom pointed retired the politician established a multi-agency hospice fraud task force. "This enactment is delivering results, arsenic much than 280 hospice licenses person been revoked implicit the past 2 years and an further 300 providers are nether investigation. The authorities continues to instrumentality coordinated enactment to suspend Medi-Cal payments, revoke licenses, and prosecute prosecutions," she said.

CBS News asked Dr. Mehmet Oz, head of the Centers for Medicare and Medicaid Services, if the effort is intended to people Newsom due to the fact that of his governmental ambitions.

"Governor Newsom is not a target. Governor Newsom is the politician of the authorities of California, wherever determination is an epidemic of fraud that should beryllium addressed and that helium has known astir for respective years," Oz responded.

The Republican-led committee is charged with launching investigations into matters of precocious nationalist interest. It astir precocious announced a probe into the allegations of fraud successful Minnesota's societal work programs. The committee besides led an probe into the backstage concern dealings of the Biden family.

Oz precocious besides sent a missive to Florida's Republican governor, Ron DeSantis, asking for documentation related to efforts to stamp retired Medicaid fraud that Oz characterized arsenic "out of control."

"Florida has been a hotspot for wellness attraction fraud for years. Taxpayers and susceptible patients merit better—and it's clip for authorities enactment to measurement up and enactment with america to halt it," helium added.