In hospice care but not dying: Inland Empire $4.2 million billing scheme alleged [The Press-Enterprise]

Press-Enterprise (Riverside, CA)

Sixteen people, including two doctors, have been charged with felonies after the state Attorney General’s Office said it uncovered a scheme in which people who were not terminally ill were enrolled in expensive hospice care without their knowledge by two Inland Empire treatment facilities that fraudulently billed Medicare for millions of dollars.

New Hope Hospice and Sterling Hospice Care have been shut down, Attorney General Rob Bonta said at a news conference on Thursday, Feb. 24, outside San Bernardino County Superior Court in Rancho Cucamonga.

The loss to Medicare and Medi-Cal from 2015 to 2021 was $4.2 million, Bonta said. Charges include conspiracy to commit insurance fraud, identity theft, grand theft, money laundering and tax evasion. Two suspects were still at large Thursday.

The defendants could face up to 27 years in prison if convicted as charged, Bonta said.

“This work is critically important because all too often we see those in their golden years and those who need care abused, neglected and taken advantage of, and all too often taxpayers are defrauded,” he said.

The operation was uncovered during an investigation into an unlicensed board-and-care facility. Investigators interviewing patients discovered that some were unaware that they had been enrolled in end-of-life care. Bonta noted that anyone receiving government benefits for hospice care is ineligible for benefits for treatment that might cure their actual illnesses.

“Some did not know what hospice was,” he said.

None of the approximately 30 victims has died, Bonta said.

According to the criminal complaint, New Hope and Sterling paid kickbacks to those who referred patients. Two officers of the companies, Ralph Canales and Giovanni Ibale, hired Romeo Rodriguez as medical director. He approved patients for hospice care regardless of whether they were dying, the complaint said. Canales and Ibale also hired another doctor, Estrella Asejo, to refer patients.

“Sometimes they would provide care, they’d provide a medical bed to an individual, an oxygen tank, a cane, a wheelchair perhaps, but mostly low cost, and they profited considerably at the expense of taxpayers,” Bonta said.

The Attorney General’s Office has reported Rodriguez and Asejo to the Medical Board of California. Their licenses are still current, according to the board’s website, which lists both doctors as graduates of Manila Central University College of Medicine.

Only Canales could immediately be found in Superior Court records. He pleaded not guilty to all charges on Tuesday.

Bonta encouraged patients to “read the fine print” before signing any documents and ask questions about the services to be provided. His office can be contacted if a scam is suspected, Bonta said.