Organized criminal networks systematically target healthcare programs with structural vulnerabilities, as demonstrated by their migration from durable medical equipment, home health, and laboratory fraud to the Medicare hospice benefit in the late 2000s and early 2010s; the hospice program's design features—federally guaranteed revenue, flat daily payment, minimal enrollment controls, no visit verification, certifiable requirements, and an elderly patient population unlikely to complain—created an exploitable system that fraud networks deliberately identified and exploited.
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Fraud Networks Didn't Stumble Into Hospice. They Went Looking for It.Added:
The answer is not simple and the honest version is more troubling than the version that looks for a single villain.
The structural answer is that Los Angeles has for some decades been a testing ground for Medicare and Medicaid fraud of all kinds. They evolved from networks that had already learned to exploit other Medicare programs, durable medical equipment, home health, laboratory services.
When federal enforcement cracked down on those fraud schemes in the late 2000s and early 2010s, some of those networks looked for the next exploitable program and the Medicare hospice benefit was exactly what they found.
Federally guaranteed revenue, flat daily payment, minimal front-end controls, no visit verification, a certification requirement that could be gained with the right doctor, a patient population elderly Medicare beneficiaries who were unlikely to complain.
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