Lawmakers are demanding answers and looking for recommendations on how to crack down on hospice fraud, a problem costing taxpayers hundreds of millions of dollars.
At a hearing on Capitol Hill Tuesday, representatives on both sides of the aisle agreed they need more accountability to protect the Medicare hospice programs, which have been raided by fraudulent operators who often use fake or stolen names to bill for end-of-life care.
“We are holding this hearing because the American people are demanding answers about the theft of their tax dollars and their Medicare benefits. To the fraudsters: your time operating in the dark is way over,” House Ways and Means Committee Chairman Jason Smith, a Republican from Missouri, said.
Tuesday’s four-hour hearing came after a CBS News investigation uncovered widespread signs of potential fraud across Los Angeles County and tracked a doctor whose Medicare reimbursement claims were spread over 126 hospice providers.
One witness who testified at the hearing, Dr. Lynn Ianni, described how she became a victim of hospice fraud after her Medicare number was stolen and used to enroll in hospice care she did not need. Ianni discovered her identity had been stolen when she sought treatment for a pickleball injury.
“My message is simply because you here have the capacity and the ability, I would like to entrust you with a responsibility as well, to take action by working together to solve this problem,” Ianni said.
Medicare fraud has become a hot political topic, with Republicans and Democrats each blaming the other party for the problem. But the reality is that fraud occurs in states led by governors from both parties.
“Tough talk is just not a substitute for an effective congressional response and effective enforcement,” said Rep. Lloyd Doggett, a Democrat from Texas.
CBS News examined the business and financial records of every hospice currently operating in LA County, applying the same indicators identified by state auditors as potential red flags for fraud.
The analysis revealed that over 700 of the roughly 1,800 hospices in LA County trigger multiple red flags for fraud as defined by the state.
The CBS News investigation also found one Los Angeles County hospice physician’s name, Dr. Rajiv Bhuva, on Medicare claims for nearly 2,800 patients across 126 California hospices in 2024, according to the last full year of available data. Bhuva told CBS News he doubted the figures and said there was no statutory limit to the number of hospices any one physician can staff. But after a brief exchange, he declined to speak further. Bhuva is no longer allowed to bill Medicare.
Sheila Clark, president and CEO of the California Hospice and Palliative Care Association, focused on what advocates call “ground zero” for hospice fraud in LA County, telling lawmakers about empty offices with mail piled up, whose owners purport to be providing hospice services.
When someone is fraudulently enrolled in hospice care, it can be difficult to get unenrolled. Many victims spend hours trying to get someone to help them remove the care they do not need and were fraudulently signed up for. Hospice care enrollment also often disqualifies them from getting other medical care they do need through Medicare.
Clark recommended Congress create a mechanism for people to get out of a fraudulent hospice enrollment, so they’re not left trapped in the system unable to get other care.
“We need better enforcement on entry. We need better enforcement at licensure, at the state level. We need it at the certification, the accreditation agencies,” Clark said. “We’re not going to convict our way out of this. We have to stop them from entering the system.”
Lawmakers asked about the long-term consequences for providers who are not fraudulent and are trying to provide desperately needed services to people at the end of their lives.
“We are rebuilding California home health and hospice; if we don’t do that, it will collapse,” Clark added.
