Literature Review

All posts tagged with “Regulatory News | Fraud & Abuse News.”



Medicare fraud has gone global. It’ll take a nationwide effort to stop it

07/16/25 at 03:00 AM

Medicare fraud has gone global. It’ll take a nationwide effort to stop itLos Angeles Times; by Mehmet Oz, Kim Brandt; 7/15/25Federal law enforcement recently announced a $14-billion fraud takedown — the largest healthcare fraud action in U.S. history, involving many crimes orchestrated by foreign nationals. Every American taxpayer should be alarmed not just because of the dollars at stake, but also because it reveals how vulnerable Medicare and Medicaid have become to large-scale, international exploitation... Fraud is a national problem, but it starts locally. Drive around certain neighborhoods in Los Angeles and you’ll pass what appear to be empty office buildings, which unbeknownst to neighbors could serve as hubs of criminal activity. There are more than 1,000 potentially fraudulent hospice operations identified in Los Angeles.Publisher's note: Medicare fraud is tragic - and that hospice is the highighted provider in this story is also tragic. This article includes steps that can be taken to stop this fraud. Also, thanks to Sheila Clark, President-CEO of the California Hospice & Palliative Care Association (CHAPCA) for forwarding this article.

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DOJ & HHS announce reinvigoration of False Claims Act Working Group and Healthcare Fraud Enforcement Priorities

07/11/25 at 03:00 AM

DOJ & HHS announce reinvigoration of False Claims Act Working Group and Healthcare Fraud Enforcement Priorities Dorsey & Whitney LLP; Press Release; 7/9/25 The Department of Justice and the Department of Health and Human Services announced the reinvigoration of a False Claims Act (“FCA”) Working Group, a joint effort between the two agencies.  The announcement was made on July 2 during remarks at the American Health Law Association (“AHLA”) Annual Meeting by Brenna Jenny, the new Deputy Assistant Attorney General of DOJ’s Commercial Litigation Branch, and in a press release that same day. This working group underscores that healthcare fraud is a priority for the Administration, despite recent staff changes and recent policy announcements about enforcement priorities in civil rights and DEI. It also underscores that robust compliance programs should continue to be a priority for healthcare-industry stakeholders.

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Health care attorneys: Hospice investigations coming from all sides

07/10/25 at 03:00 AM

Health care attorneys: Hospice investigations coming from all sides Hospice News; by Jim Parker; 7/8/25 Hospices are subject to a rising number of investigations and audits from Medicare contractors, the U.S. Department of Health and Human Services Office of the Inspector General and, in some cases, the U.S. Justice Department, among others. Hospices need to understand the various types of investigations they may encounter and how to respond to them. Key factors are completely and accurately documenting the medical necessity of the care they receive. Hospice News sat down with Guillermo Beades and Todd Brower, partners with the law firm Frier Levitt to discuss the ins-and-outs of hospice investigations and how providers should respond.

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Two California residents plead guilty in connection with $16M hospice fraud scheme and money laundering scheme

07/09/25 at 03:00 AM

Two California residents plead guilty in connection with $16M hospice fraud scheme and money laundering schemeDOJ press release; 7/8/25Two California residents pleaded guilty yesterday in connection with their roles in defrauding Medicare of nearly $16 million through sham hospice companies and to laundering the proceeds of the fraud as part of a multi-year scheme. According to court documents, Karpis Srapyan, 35, of Winnetka, California, conspired with others, including co-defendants Petros Fichidzhyan and Juan Carlos Esparza, to bill Medicare for hospice services that were not medically necessary and never provided. To conduct their fraudulent scheme, they used a series of four sham hospice companies: one owned by Esparza and the other three owned by foreign nationals but controlled by the defendants. Srapyan and his co-defendants concealed the scheme by using foreign nationals’ personal identifying information to open bank accounts, submit information to Medicare, and sign property leases. They also misappropriated names and other identifying information of several doctors, two of whom were deceased, to fraudulently bill Medicare for purported hospice services. In total, Medicare paid the fake hospice companies nearly $16 million.

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CMS launches new model to target wasteful, inappropriate services in original Medicare

07/07/25 at 03:00 AM

CMS launches new model to target wasteful, inappropriate services in original Medicare CMS Newsroom; 6/27/25 The Centers for Medicare & Medicaid Services (CMS) is announcing a new Innovation Center model aimed at helping ensure people with Original Medicare receive safe, effective, and necessary care. Through the Wasteful and Inappropriate Service Reduction (WISeR) Model, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to Original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars. This model builds on other changes being made to prior authorization as announced by the U.S. Department of Health and Human Services and CMS on [6/23].

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Case Summaries: 2025 National Health Care Fraud Takedown

07/07/25 at 03:00 AM

Case Summarie: 2025 National Health Care Fraud Takedown Criminal Division, U.S. Department of Justice; retrieved from the internet 7/3/25[Gleaned from this lengthy article for "hospice" involvement:] Criminal Division | Case Summaries

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United Palliative & Hospice Care accused of $87M hospice scam

07/03/25 at 02:00 AM

United Palliative & Hospice Care accused of $87M hospice scam Hospice News; by Jim Parker; 7/2/25 Three women associated with Houston-based United Hospice & Palliative Care (UPHC) have been charged with Medicaid and Medicare fraud after allegedly bilking more than $87 million in federal health care funds. The trio includes UPHC owner Dera Ogudo, an UPHC employee Victoria Martinez and a psychiatric hospital employee, Evelyn Shaw, ABC-13 Houston reported. The prosecutor’s indictment also includes an unnamed physician who allegedly received kickbacks for referrals to UPHC. “Ogudo and her co-conspirators preyed on the vulnerable residents of those group homes by enrolling them in hospice services with UPHC when they were not terminally ill,” the indictment indicated.

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Nearly 50 charged in Southern District of Texas as part of national health care fraud takedown

07/02/25 at 03:00 AM

Nearly 50 charged in Southern District of Texas as part of national health care fraud takedown United States Attorney's Office - Southern District of Texas, Houston, TX; 6/30/25 A total of 22 cases are being announced as part of local efforts targeting health care fraud and include various schemes alleging unlawful distribution of controlled substances, some of which were diverted onto the black market, hospice fraud, kickbacks and other Medicare/Medicaid fraud schemes involving medically unnecessary genetic tests, durable medical equipment and more.  The charges filed in Southern District of Texas (SDTX) federal court are part of the Department of Justice’s 2025 national health care fraud takedown. ... One of the largest cases include three individuals for their alleged roles in a $110 million hospice fraud and kickback scheme. The charges allege Dera Ogudo, 39, and Victoria Martinez, 35, both of Richmond, operated hospice company United Palliative & Hospice Company (UPHC) that misled vulnerable elderly adults about what services were being billed to their Medicare and Medicaid plans.

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National Health Care Fraud Takedown results in 324 defendants charged in connection with over $14.6 billion in alleged fraud: Largest Justice Department Health Care Fraud Takedown in history, more than doubles prior record of $6 billion

07/01/25 at 03:00 AM

National Health Care Fraud Takedown results in 324 defendants charged in connection with over $14.6 billion in alleged fraud: Largest Justice Department Health Care Fraud Takedown in history, more than doubles prior record of $6 billion Office of Public Affairs - U.S. Department of Justice, Washington, DC; 6/30/25 The Justice Department today announced the results of its 2025 National Health Care Fraud Takedown, which resulted in criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals, in 50 federal districts and 12 State Attorneys General’s Offices across the United States, for their alleged participation in various health care fraud schemes involving over $14.6 billion in intended loss. The Takedown involved federal and state law enforcement agencies across the country and represents an unprecedented effort to combat health care fraud schemes that exploit patients and taxpayers.Editor's Note: For cases specific to hospice and palliative care, (1) go to our homepage, (2) ;ogin to your newsletter account, (3) use the search engine at the top of our page, using the key word "fraud". We have posted  204 articles about hospice fraud, since we began this format on 1/1/2024. Ongoing, use this search engine as your first "Go To" resource for targeted, timely information.

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Artificial intelligence and health care waste—Promise or peril?

06/28/25 at 03:45 AM

Artificial intelligence and health care waste—Promise or peril?JAMA Health Forum; William H. Shrank, MD, MSHS; Suhas Gondi, MD, MBA; David J. Brailer, MD, PhD; 6/25One obvious target of AI [artificial intelligence] tools in health care is the reduction of waste. While LLM [large language model] applications to health care are still nascent—many still make errors, and more rigorous evaluations are needed—most agree that the long-term opportunity for AI in health care is tremendous. A recent study estimated that widespread adoption of AI could lead to savings of 5% to 10% of total US health care spending. Realizing even a fraction of this potential would increase the affordability of care for people in the US and free substantial societal resources to make other valuable investments. But getting there will require deliberate choices from leaders and policymakers and careful attention to risks that could set back progress.

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California man pleads guilty in connection with laundering proceeds of $16M hospice fraud scheme

06/26/25 at 03:00 AM

California man pleads guilty in connection with laundering proceeds of $16M hospice fraud schemeUS Department of Justice press release; 6/23/25A California man pleaded guilty today to laundering more than $4.6 million in connection with a years-long scheme to defraud Medicare of nearly $16 million through sham hospice companies. According to court documents, Mihran Panosyan, ...worked with others to launder the proceeds of a massive Medicare fraud scheme, transferring the fraudulently obtained funds between multiple accounts before spending them. The scheme comprised three parts. First, three of Panosyan’s co-defendants used the identities of foreign nationals no longer in the United States to operate several sham hospice companies... Second, the co-defendants caused the submission of false and fraudulent claims to Medicare for hospice services for patients who were not terminally ill and who never requested nor received hospice services... Third, Panosyan and his co-defendants laundered the proceeds of the scheme to conceal the source of the funds and their control over them... He faces a maximum penalty of 20 years in prison.

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Whistleblowers receive $1.5 million for exposing alleged hospice kickback scheme

06/25/25 at 03:00 AM

Whistleblowers receive $1.5 million for exposing alleged hospice kickback schemeWhistleblower Network News; by Geoff Schweller; 6/18/25On June 11, the U.S. Attorney for the Northern District of Georgia announced that Creative Hospice Care, Inc., and affiliated companies paid $9.2 million to settle whistleblower allegations that the entities violated the False Claims Act by entering into kickback arrangements with medical directors in exchange for referrals of hospice patients to Creative Hospice.

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Georgia hospice provider reaches $9.2M settlement with DOJ over kickback allegations

06/16/25 at 03:00 AM

Georgia hospice provider reaches $9.2M settlement with DOJ over kickback allegations McKnights Home Care; by Adam Healy; 6/13/25 Georgia-based Creative Hospice Care Inc paid the Department of Justice $9.2 million to settle claims that it entered kickback arrangements with medical professionals in exchange for patient referrals, the DOJ disclosed Wednesday. “Decisions regarding end-of-life care are incredibly difficult and personal, and families must be able to trust the intentions of their chosen providers,” Georgia Attorney General Chris Carr said in a statement. “Those who instead take advantage of the system for their own personal gain will be held accountable.”

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CMS budget proposal would shift nursing facility oversight

06/06/25 at 03:00 AM

CMS budget proposal would shift nursing facility oversight Becker's Hospital Review; by Elizabeth Gregerson; 6/4/25 Key changes put forth in President Donald Trump’s proposed fiscal year 2026 budget may have downstream effects on the survey and certification of skilled nursing facilities. ... Here are three things to know about the proposed changes:

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For Public Awareness: If you think you may have experienced Medicare hospice fraud, call 1-800-Medicare to report it.

06/06/25 at 02:00 AM

Public: If you think you may have experienced Medicare fraud, call 1-800-Medicare to report it. Posted on X; by Mehmet Oz, "DrOzCMS"; 6/2/25 There’s a Medicare scam out there that can really hurt people, and I want to make sure you’re aware! People are targeting older Americans to trick them to sign up for Hospice without their knowledge.   If you think you may have experienced fraud, call 1-800-Medicare to report it.  To learn more, go to http://Medicare.gov/fraud.

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Experts warn of scams during Medicare Fraud Prevention Week

06/05/25 at 03:30 AM

Experts warn of scams during Medicare Fraud Prevention Week Public News Service; by Suzanne Potter; 6/4/25 Medicare loses $60 billion to $80 billion a year to fraud and this year, for Medicare Fraud Prevention Week, your local Senior Medicare Patrol has good advice on how to spot a con. There are plenty of scams to be aware of. Karen Joy Fletcher, communications director with the nonprofit California Health Advocates, said beware if a caller asks to verify your Medicare number, claiming the program needs to send out a new type of card. ... ... Caregivers can be on the lookout for medical equipment arriving at the house even though the beneficiary never ordered it. Another red flag? A stranger may approach you in a parking lot asking you to sign up for new, free Medicare services like house cleaning or meals, which are then fraudulently billed to the government. ... Another scam involves tricking people into unknowingly signing up for hospice care. It is especially dangerous, because once a person is on hospice, Medicare will only approve palliative care and could mistakenly deny an essential surgery or medication.

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CMS budget puts complaint surveys over routine inspections as main nursing home oversight

06/05/25 at 03:15 AM

CMS budget puts complaint surveys over routine inspections as main nursing home oversight McKnights Long-Term Care; by Kimberly Marselas; 6/2/25 A proposed 2026 Trump administration budget request would shift nursing home survey priorities, further delaying the time between standard inspections at many facilities. The Centers for Medicare & Medicaid Services budget justification published late Friday calls for a $45 million increase in survey spending across multiple sectors next fiscal year. But it also prioritizes complaint surveys in a way that would reduce the availability of surveyors to conduct routine, annual inspections mandated by law. The document from the Department of Health and Human Services shows the percentage of nursing home standard surveys completed each year would fall from 74% in fiscal year 2024 to a projected 65% completion rate in fiscal year 2026. 

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TCN/HPC Today: Storm clouds on the horizon for reimbursement

06/05/25 at 03:00 AM

TCN/HPC Today: Storm clouds on the horizon for reimbursement - Top news stories, May 2025 Teleios Collaborative Network (TCN); podcast by Chris Comeaux with Cordt Kassner, 6/4/25 What happens when artificial intelligence meets end-of-life care?  How do we reconcile private equity's profit motives with hospice's mission-driven ethos?  These questions took center stage in this month's roundup of hospice news with host Chris Comeaux and guest Cordt Kassner. The May edition of TCNtalks' top news stories reveals a healthcare sector at a fascinating crossroads.  AI has emerged as both a tantalizing promise and a practical challenge for hospice providers.  ... In this episode of TCN Talks, hosts Chris Comeaux and Cord Kassner reflect on Memorial Day and discuss significant news stories from May, including the complexities of thanking veterans for their service, the role of artificial intelligence in hospice care, and the importance of honest conversations about racism in healthcare.Editor's note: This monthly podcast combines quantitative data and qualitative discussion from articles gleaned from the 400+ posts we provide each month. Do you seek to make sense of it all? Tune in and learn. We welcome your feedback via our newsletter's Contact page. 

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2 West Covina women arrested for alleged $4.8 million hospice care fraud

06/04/25 at 03:00 AM

2 West Covina women arrested for alleged $4.8 million hospice care fraud CBS News KCAL, Los Angeles, CA; by Julie Sharp; 6/3/25 The U.S. Department of Justice announced that two West Covina women were arrested Tuesday for an alleged scheme to defraud Medicare of $4.8 million with false hospice care claims. One of the women who was arrested is the owner and operator of two West Covina hospices, Golden Meadows Hospice Inc., and D'Alexandria Hospice Inc., which billed Medicare for hospice services for patients who were allegedly not terminally ill.  Between Sept. 2018 and Oct. 2022, owner and operator Normita Sierra, 71, and her alleged accomplice, Rowena Elegado, 55, collected more than $3.8 million from Medicare on false claims, the DOJ said.

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Saugus nurse arrested in FBI raid for alleged part in $2.5 million Medicare [hospice] fraud

06/03/25 at 02:15 AM

Saugus nurse arrested in FBI raid for alleged part in $2.5 million Medicare [hospice] fraud KHTS - Santa Clarita News, Santa Clarita, CA; by Jade Aubuchon; 5/30/25 Jessa Zayas, aka Jessa Contreras, a vocational nurse, is believed to have committed medicare fraud through two different hospice providers, submitting more than $2,500,000 in fraudulent claims to Medicare. Zayas is the Chief Executive Officer of two hospice providers, Healing Hands Hospice Inc. and Humane Love Hospice. From June 2023 through February 2025, she caused Healing Hands and Humane Love to bill Medicare for millions of dollars’ worth of hospice services that were not medically necessary, not authorized by a physician, and were not actually provided to the patients. ...

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CMS rolls out aggressive strategy to enhance and accelerate Medicare Advantage audits

05/27/25 at 03:00 AM

CMS rolls out aggressive strategy to enhance and accelerate Medicare Advantage audits CMS Newsroom; Press RElease; 5/21/25 Agency Will Begin Auditing All Eligible Medicare Advantage Contracts Each Payment Year and Add Resources to Expedite Completion of 2018 to 2024 AuditsToday, the Centers for Medicare & Medicaid Services (CMS) announced a significant expansion of its auditing efforts for Medicare Advantage (MA) plans. Beginning immediately, CMS will audit all eligible MA contracts for each payment year in all newly initiated audits and invest additional resources to expedite the completion of audits for payment years 2018 through 2024.

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UnitedHealth Group is under criminal investigation for possible Medicare fraud

05/16/25 at 02:00 AM

UnitedHealth Group is under criminal investigation for possible Medicare fraud The Wall Street Journal; by Christopher Weaver and Anna Wilde Mathews; 5/15/25 The Justice Department is investigating UnitedHealth Group for possible criminal Medicare fraud, people familiar with the matter said. The healthcare-fraud unit of the Justice Department’s criminal division is overseeing the investigation, the people said, and it has been an active probe since at least last summer. While the exact nature of the potential criminal allegations against UnitedHealth is unclear, the people said the federal investigation is focusing on the company’s Medicare Advantage business practices. UnitedHealth said in a statement it hadn’t been notified by the Justice Department of the criminal investigation. The statement said the company stands “by the integrity of our Medicare Advantage program.” A DOJ spokesman declined to comment.

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New York bill aims to ban new for-profit hospices amid fraud concerns

05/15/25 at 02:15 AM

New York bill aims to ban new for-profit hospices amid fraud concerns CBS WRGB-6, Albany, NY; by Lara Bryn; 5/14/25 A new bill awaiting the governor's signature could ban the establishment of new for-profit hospices in New York, a move lawmakers and industry experts say is necessary to improve care quality and prevent potential fraud. ... The bill has already passed in both the state Senate and House. The push for this legislation comes in part due to findings from national studies by the American Medical Association and ProPublica, which highlighted issues in for-profit hospice care. ... Jeanne Chirico, CEO of the Hospice and Palliative Care Association of New York State, said, "To try and make a quick turnaround of profit either through falsifying eligibility records or by fraudulently submitting records for individuals who never even knew they were on hospice." Chirico noted a case where a New York Medicare recipient was unknowingly enrolled in a hospice-certified program based in California. 

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Be ready for updated Special Focus Program, hospice experts say

05/13/25 at 03:00 AM

Be ready for updated Special Focus Program, hospice experts sayMcKnight's Home Care; by Adam Healy; 5/9/25A revised hospice Special Focus Program is coming, and providers should make sure they have plans and procedures in place to be successful under this strict oversight program, Linda Woodle, director of accreditation at Community Health Accreditation Partner (CHAP), and Patricia D’Arena, vice president of clinical excellence at Enhabit Home Health and Hospice, said... When that program will be reinstated is anyone’s guess... The Centers for Medicare & Medicaid Services has indicated that assessments will place a high emphasis on four specific Conditions of Participation: patient’s rights; initial and comprehensive assessment of the patient; interdisciplinary group, care planning and coordination of care; and quality assessment and performance improvement. So providers should ensure they meet all of these conditions’ requirements.

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California man sentenced to 12 years’ imprisonment in connection with $17m Medicare fraud schemes

05/08/25 at 03:00 AM

California man sentenced to 12 years’ imprisonment in connection with $17m Medicare fraud schemes U.S. Department of Justice - Office of Public Affairs; Press Release; 2/6/25 A California man was sentenced yesterday to 12 years in prison and three years of supervised release for his role in 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, 44, of Granada Hills, schemed with others to bill Medicare for hospice services that were not medically necessary and never provided. Fichidzhyan and his co-schemers controlled hospice entities and used foreign nationals’ personal identifying information (PII) to conceal the scheme, using the PII to, among other things, open bank accounts, submit information to Medicare, and sign property leases.

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