Rowegie Abanto

California hospice fraud crackdown expands into probe on patient eligibility. Photo from Unsplash

Article (news)

California hospice fraud crackdown 

<div><span class="fr-img-caption fr-fic fr-dib" style="width:960px;display:block" width="960"><span class="fr-img-wrap"><img src="https://od2-image-api.abs-cbn.com/prod/editorImage/1775793233483annabel-podevyn-fUBZHfDAVmc-unsplash (1).jpg" style="width:960px" class="fr-fic fr-dib" width="960"/><span class="fr-inner" style="text-align:left">California hospice fraud crackdown expands into probe on patient eligibility. <em>Photo from Unsplash</em></span></span></span></div><p>SACRAMENTO — Governor Gavin Newsom and Attorney General Rob Bonta have announced a sweeping crackdown on a massive hospice fraud and identity theft scheme targeting California&#x27;s Medi-Cal program, which federal authorities warn could signal a broader, systemic problem across the US healthcare system.</p><p>At the center of the case is an alleged network of transnational actors accused of using stolen identities to fraudulently enroll patients into Medi-Cal and bill for hospice services that were never provided. Investigators say the operation involved 14 fraudulent hospice providers and generated more than $267 million in improper claims paid with taxpayer funds.</p><p>State officials framed the enforcement action as both accountability and warning.</p><p>“This isn’t a political game for us. This is about protecting taxpayer dollars, protecting the programs that sick and vulnerable Californians rely on, and protecting our state,” Bonta said. </p><p>He added that over the life of the scheme, not a single legitimate hospice service was provided despite millions being billed. </p><p>“This wasn’t a mistake or a loophole; it was deliberate fraud,” he said, warning that such abuse undermines trust, drains critical resources, and threatens care for those who depend on it. </p><p>“We have taken a firm stand to investigate, prosecute, and shut down hospice fraud wherever it exists.”</p><p>While the arrests mark a significant state-level action, federal agencies — including the US Department of Justice, the Federal Bureau of Investigation, the Internal Revenue Service, and the Centers for Medicare &amp; Medicaid Services — are now expanding the investigation, treating the case as part of a wider probe into what officials describe as the &quot;industrialization&quot; of hospice eligibility.</p><div><br/></div><div><strong>LEVEL OF COORDINATION</strong></div><div><br/></div><p>What began with a series of arrests has evolved into a deeper inquiry tracing financial transactions, referral pipelines, and physician certifications. </p><p>Early findings suggest the alleged scheme may have operated with a level of coordination that goes beyond traditional fraud, potentially systematizing how patients were deemed eligible for end-of-life care.</p><p>Rather than responding to legitimate medical needs, investigators believe the network may have identified individuals who could qualify for hospice on paper, regardless of their actual condition — effectively turning eligibility into a scalable business model.</p><p>That shift is drawing heightened scrutiny. Under federal rules, hospice enrollment requires a physician’s certification that a patient is terminally ill, typically with a life expectancy of six months or less. </p><p>Authorities now suspect that in some cases, those determinations may have been reduced to routine approvals instead of critical medical judgments.</p><p>Data is also driving the expanding probe. Analysts have flagged unusually high &quot;live discharge&quot; rates — patients who leave hospice care because their health does not decline as expected — as a potential red flag. Once seen as a minor irregularity, that metric is now being used to identify patterns of abuse, prompting broader reviews of hospice providers nationwide.</p><p>Beyond the financial toll, officials are increasingly focused on the human cost. Hospice care fundamentally shifts treatment away from curative efforts toward comfort-based support. If patients were placed into hospice prematurely, investigators warn, it raises the possibility that medical decisions were influenced not by need, but by profit.</p><div><br/></div><div><strong>ARRESTS</strong></div><div><br/></div><p>Earlier in the investigation, authorities confirmed the arrest of eight individuals allegedly linked to the same or closely connected hospice fraud operations. </p><p>Among those taken into custody were individuals of diverse backgrounds, including some with ties to the Filipino community, highlighting how far-reaching and organized the network may have been. </p><p>Prosecutors allege the group played key roles in building and managing hospice entities, recruiting patients, and facilitating the billing structure that allowed millions in false claims to move through the system.</p><div><a href="https://www.abs-cbn.com/news/world/2026/4/7/filipino-operators-among-8-arrested-in-50-million-hospice-fraud-targeting-the-dying-in-socal-1048">Filipino operators among 8 arrested in $50-million hospice fraud targeting the ‘dying’ in SoCal</a></div><p>Investigators now believe those earlier arrests may represent just one segment of a larger, interconnected web of operators, raising the possibility that similar models have been replicated across different regions.</p><p>Agencies are coordinating more closely, combining healthcare oversight with financial crime analysis to map how these networks operate — from recruitment to reimbursement and, in some cases, alleged money laundering.</p><div><br/></div><div><br/></div><div><strong>FROM THE ARCHIVES</strong></div><div><strong><br/><span class="fr-video fr-deletable fr-fvc fr-dvb fr-draggable" contenteditable="false" draggable="true"><iframe width="640" height="360" src="https://www.youtube.com/embed/K57BYO3FcCU?&amp;wmode=opaque&amp;rel=0" frameBorder="0" allowfullscreen="" class="fr-draggable"></iframe></span><span class="fr-video fr-deletable fr-fvc fr-dvb fr-draggable" contenteditable="false" draggable="true"><iframe width="640" height="360" src="https://www.youtube.com/embed/DOL9fHKbMbk?&amp;wmode=opaque&amp;rel=0" frameBorder="0" allowfullscreen="" class="fr-draggable"></iframe></span></strong><br/></div>

<p>At the center of the case is an alleged network of transnational actors accused of using stolen identities to fraudulently enroll patients into Medi-Cal and bill for hospice services that were never provided.</p>

At the center of the case is an alleged network of transnational actors accused of using stolen identities to fraudulently enroll patients into Medi-Cal and bill for hospice services that were never provided.

California hospice fraud crackdown expands into national probe on 'industrialized' patient eligibility

News

Entertainment

Lifestyle

Sports

Metro.Style

More

Sudoku

Word of the Day

Lotto

Horoscope

World

California hospice fraud crackdown expands into national probe on 'industrialized' patient eligibility

Rico Lucena,

ABS-CBN North America

Published April 10, 2026 12:27 PM PHT

Read More:

Medi-Cal

Hospice Care

California

Hospice

Fraud

Healthcare Fraud

ABS-CBN is the leading media and entertainment company in the Philippines, offering quality content across TV, radio, digital, and film. Committed to public service and promoting Filipino values, ABS-CBN continues to inspire and connect audiences worldwide.

Corporate

Investors

Governance

International Distribution

Corporate

Governance

Investors

International Distribution

NPC Seal of Registration

Privacy Policy

AI Policy

Terms of Service

Advertise with Us

© 2026 ABS-CBN Corporation. All Rights Reserved.

NPC Seal of Registration

Privacy Policy

Terms of Service

AI Policy

Advertise with Us

© 2026 ABS-CBN Corporation. All Rights Reserved.

NPC Seal of Registration

Privacy Policy

Terms of Service

AI Policy

Advertise with Us

© 2026 ABS-CBN Corporation. All Rights Reserved.