Dr. Mehmet Oz pledged this week to lead an effort to decertify any hospice providers found defrauding taxpayers by stealing the identities of people not in hospice or by overbilling for those who are dying.
“If they steal the money, they’ll steal your health, they’ll steal your life, and we’re seeing that over and over again, which is why we have to send a very loud message to fraudsters that we’re not open for business for you,” said Oz, who is the Trump administration’s administrator for the Centers for Medicare and Medicaid Services (CMS).
“Run away, defraud somebody else, go into some other illegitimate business, but do not steal from the American people,” he added in an exclusive interview with CBS News.
Hospice care offers patients who are terminally ill the ability to treat pain and die with dignity. But in recent years, the industry has suffered due to bad actors billing the federal government for services they never provided or for patients who are not even sick.
Oz’s comments came in response to a CBS News examination of state and federal data raising concerns about potentially fraudulent charges, notably in California, where an outsized number of companies offer hospice services. The investigation found that over 700 of the roughly 1,800 hospices in Los Angeles County triggered multiple red flags for fraud as defined by the state.
Nationwide, the U.S. Department of Health and Human Services Office of the Inspector General reported in 2023 that suspected hospice fraud amounts to an estimated $198.1 million.
The agency headed by Oz plays a crucial role in overseeing hospice care. Since Medicare is federally administered, hospices must be certified to receive reimbursements made with taxpayer dollars.
“My plan is to do just that — to take half the hospices in California, the ones that are illegitimate based on the criteria we’ve been discussing today, and take away their ability to bill us,” Oz said.
“Forty-nine states do not have the kinds of problems that Los Angeles County has,” he continued. “All of us together are going to have to make some tough decisions—Democrats and Republicans, red and blue, doesn’t matter.”
California is confronting this problem as Governor Gavin Newsom, a Democrat, eyes a potential presidential run. Fraud in public services has become a thorny political issue, with Republicans and an army of social media influencers seizing on it as politically potent. They accuse Democratic state leaders of failing to prevent costly schemes.
However, Oz said he isn’t sure if there is a greater willingness from California to share information and fix the problem together.
CBS News reached out to Newsom’s office for a response to Dr. Oz’s allegations. A spokesperson for Newsom told CBS News, “California has always been ready and willing to engage constructively with the federal government over anti-fraud efforts. The state cracked down on hospice fraud years ago.”
The statement also notes that the state launched a multi-agency Hospice Fraud Task Force, which makes arrests, shares intelligence, investigates fraud, and coordinates enforcement.
State officials told CBS News it is far from true that California is not engaging in good faith with the federal government, and they stand ready to partner together. The state has revoked around 280 hospice licenses to date.
For its part, Oz said CMS made a checklist of tactics used in fraud schemes; those red flags will trigger on-site visits by the agency to investigate and determine what is illegitimate.
Behind the hundreds of millions of dollars fraudulently charged to the federal government across the country are real victims whose identities are stolen and who might have trouble getting the care they desperately need.
“I didn’t feel protected. I didn’t feel safe,” said Lynn Ianni, whose Medicare number was stolen and used to fraudulently enroll her in hospice care she didn’t need. “I felt, like, abused by a system that didn’t work, that was truly broken, and without a remedy from that same system. It was really frustrating.”
https://www.cbsnews.com/news/dr-oz-pledges-to-tackle-hospice-fraud/
