California Attorney General Rob Bonta announced on November 5, 2025, the sentencing of a husband and wife, who owned and operated a hospice provider company, for submitting false claims to the Medicare and Medi-Cal programs. The husband was sentenced to seven years and four months in state prison and was jointly ordered to pay $1,455,233 alongside his wife. The wife was sentenced to one year in jail and was ordered to abstain from working with Medicare and Medi-Cal beneficiaries in a caregiver or fiduciary capacity and from working for any healthcare provider that receives funds from Medicare or Medi-Cal. The prosecution of these individuals was carried out by the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse.
From 2013 through 2022, the husband and wife, along with the husband’s brother and another couple, operated four hospice providers in California’s Inland Empire region (a metropolitan area east of Los Angeles). The husband played a primary role as owner and operator of these companies, while his wife played a supporting role under his direction. During this time, the individuals paid illegal kickbacks, in the form of cash and personal checks, to illicit marketers and to two area doctors who certified patients for hospice services even though the patients were not suffering from terminal conditions.
Across the four companies, at least 52 patients were identified as being ineligible to receive hospice care, substantially defrauding the Medicare and Medi-Cal programs. In addition to committing fraud against these programs, the husband and wife failed to pay corporate taxes to the California Franchise Tax Board and the California Employment Development Department.
“Medi-Cal and Medicaid exist to serve our most vulnerable communities. They are lifelines, not opportunities for exploitation,” said Attorney General Bonta. “Let me be clear: Those who defraud these vital programs are not just breaking the law. They are stealing from taxpayers, endangering patient care, and betraying the public trust. At the California Department of Justice, we will not tolerate it. We will continue to aggressively pursue those who abuse these programs for personal gain and hold them accountable to the fullest extent of the law.”
Compliance Perspective
Issue
All medical services billed to Medicare, Medicaid, or other healthcare programs must be medically necessary and properly documented. Hospice services are covered only for patients who are terminally ill—defined as having a life expectancy of six months or less if the illness runs its normal course. Inaccurate eligibility determinations, insufficient documentation, or inappropriate referral practices can result in false claims and violations of federal law. Providers are responsible for maintaining compliance through effective policies, comprehensive staff education, and consistent monitoring of program integrity.
Discussion Points
- Review policies and procedures related to hospice services to ensure alignment with current Medicare and Medicaid regulations. Policies should clearly define eligibility requirements, documentation standards, referral processes, and safeguards against improper billing or kickbacks. Facilities may consider engaging a healthcare consultant to assist in evaluating compliance programs, identifying potential risk areas, and supporting the implementation of best practices.
- Provide ongoing education and training for staff involved in hospice services, including nursing, social services, and administrative personnel. Training should reinforce eligibility criteria, documentation expectations, and ethical standards for referrals and billing. Med-Net Academy offers the course Business Ethics, which discusses the definition of ethics and its key values, potential conflicts of interest, ethical business practices, the importance of honest communication, the duty to report, and practices to avoid.
- Conduct regular audits to confirm that hospice services meet Medicare and Medicaid eligibility requirements and that documentation supports medical necessity. Focused or modified audits can help identify compliance gaps early, particularly in areas highlighted through Quality Assurance and Performance Improvement (QAPI) activities. Partnering with an external consultant for mock or specialized audits can provide objective assessments, reinforce accountability, and help facilities prepare for survey or review activity.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*