Eli's Hospice Insider

Published on Thu Jan 21, 2016 PDF

Plus: Hospice physicians indicted in California scheme.

If you think the worst you’ll get from a Medicare contractor review is a recoupment notice, think again. An investigation of Iowa Hospice by Zone Program Integrity Contractor NCI Advance-Med has led to a $1.1 million false claims settlement.        The hospice knowingly submitted claims for patients who didn’t have a six-month prognosis, the Department of Justice says in a release.

“Hospice providers that try to boost their profits by providing hospice care to Medicare beneficiaries who are not terminally ill compromise both the health of those patients as well as the financial integrity of Medicare,” the HHS Office of Inspector General’s Gerald T. Roy says in the release. “Our agency will continue to hold such hospice providers accountable for their actions.”

In another hospice case: Back in 2008, home health agency owner Priscilla Villabroza, a registered nurse who ran a Santa Fe Springs-based company called Medcare Plus Home Health Providers, pleaded guilty in federal court to five counts of health care fraud (see Eli’s HCW, Vol. XVIII, No. 25). From 2004 to 2007, Villabroza and others hired unlicensed individuals to provide services to disabled Medi-Cal patients and billed the state’s Medicaid program as if they were licensed vocational nurses. Villabroza is serving a prison sentence of four-and-a-half years for the charges.

Now Villabroza has been indicted for running a hospice scam while she was under investigation for the earlier fraud. Villabroza and her daughter, Sharon Patrow, allegedly purchased California Hospice in 2007 and submitted $9 million in fraudulent claims. They are accused of paying recruiters to bring in patients that were falsely assessed by nurses and falsely certified by two doctors, according to the indictment.

The other defendants in the case are physician and recruiter Sri Wijegoonaratna, physician Boyoa Huang, RN and recruiter Nancy Briones and recruiter Roseilyn Montana. Five of the defendants pleaded not guilty and will be facing trial Feb. 10, reports the San Gabriel Valley Tribune. Villabroza has pled guilty and faces sentencing April 25, reports the Orange County Register.