Health workers pretended constipated man with dementia was dying and only had months to live so they could reap ‘sham hospice’ benefits

An elderly California man with dementia who visited a hospital for abdominal pain and constipation — caused by a fecal mass in his colon — was enrolled in hospice care even though he “was fine” after the visit and “did not need palliative care,” according to the Justice Department.

The Glendale-based company 626 Hospice Inc., operating as St. Francis Palliative Care, allegedly misrepresented the man’s condition and falsely claimed he was terminally ill to collect Medicare payments.

Owner Gladwin Gill, 66, a psychologist, and his wife, Amelou Gill, 70, a registered nurse, face federal charges for health care fraud, along with others running hospice companies in the Los Angeles area that allegedly billed Medicare for patients who were not terminally ill, court documents show.

The alleged schemes generated more than $50 million in Medicare payments. “Some of the patients were unaware they were enrolled in hospice,” a federal complaint says. The complaint states that 626 Hospice repeatedly enrolled and re-enrolled patients who were never informed they had six months or less to live, despite listing them as having terminal diagnoses.

One patient, identified as V.J., was 95 years old and had Alzheimer’s disease. According to the DOJ, no doctor or nurse informed him he was dying. V.J., a Kaiser Permanente patient, had previously recovered from prostate cancer and an aneurysm. After a May 28, 2020 hospital visit for abdominal pain, doctors determined he had a fecal mass but made no further diagnosis. He appeared to feel well afterward, and his primary care doctor had never diagnosed him with a terminal condition or referred him to hospice.

Investigators found that 626 Hospice had been enrolling V.J. in its palliative care system since May 2018, more than a year before any hospice services were even considered necessary. A 2019 referral by a palliative social worker was later determined by a nurse to be unnecessary, and V.J.’s family confirmed he did not need palliative care.

V.J.’s daughter told federal investigators that she never understood how her father came to receive services from St. Francis Palliative Care. She described the staff as “okay” but said they often did not show up as scheduled and did not provide all the services billed to Medicare.

Federal prosecutors say V.J.’s case is just one of many used to defraud Medicare of more than $50 million. Some patients were allegedly aware of their enrollment, while others were not. One former 626 Hospice employee reported that a family complained because a patient signed a hospice consent form without being told he had six months or less to live.

Other patients cited in the complaint include H.G., who received visits from nurses and a social worker to monitor her health but was never informed she was terminally ill, and T.U., who noted he had previously been on hospice years ago but was still alive.

Gladwin and Amelou Gill are charged with health care fraud and are scheduled for a preliminary hearing on April 23.

“They schemed to defraud the nation’s health care system out of more than $50 million, including by running sham hospice facilities that billed Medicare for patients without terminal illnesses,” the DOJ said.

First Assistant United States Attorney Bill Essayli added, “We are enforcing a zero-tolerance policy for criminals who defraud American taxpayers. The defendants arrested are charged with stealing millions of dollars in health care benefits and now face years in federal prison.”

original source