87-year-old physician’s Medicare quantity linked to $600M in fraud

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On a busy, gritty avenue in suburban Los Angeles, the white one-story stucco constructing regarded like another. Among the many flats, places of work, sidewalk bodegas, the one defining characteristic was the constructing's door – a thick, strong slab of darkish oak with a small, safety grill about six inches sq..

"Is Dr. Faustina right here," I requested. "That is his handle of document with the medical board."

A face appeared within the cutout, "He would not work right here."

That is odd, I assumed, contemplating a number of residence healthcare companies at this handle had billed Medicare greater than $40 million {dollars} utilizing 87-year-old Dr. Gilbert Faustina's Medicare quantity, in line with federal information.

LOS ANGELES COUNTY FACES SCRUTINY AFTER ALLEGED WIDESPREAD HOSPICE FRAUD EXPOSED

Healthcare fraud is reportedly a giant enterprise in Los Angeles. (Myung J. Chun / Los Angeles Occasions through Getty Photos)

But as a number of state and federal audits have proven, healthcare fraud in Los Angeles is huge enterprise, with taxpayer losses estimated at $3.5 billion.

Lawmakers on Capitol Hill are demanding federal inspectors train stronger oversight to fight what they name "massive scale fraud" with sufferers receiving inappropriate or nonexistent care, with docs signing off on affected person care plans having by no means met the affected person, and hospice and residential well being suppliers utilizing a number of licenses to 'shuffle' sufferers from one company to a different to flee state and federal audits.

Dr. Ira Byock, a nationwide knowledgeable on residence healthcare and the creator of a number of books, describes how the shell sport works.

LOS ANGELES HOSPICE FRAUD REACHES BILLIONS AS MEDICARE PROVIDERS SCAM FEDERAL SYSTEM WITH FAKE COMPANIES

"You may have three or 4 or 10 of them working out of a single handle, with completely different names and completely different licenses, however they're all solely serving just a few sufferers which retains them at a degree underneath the radar of the Medicare's standards for serving hospice applications," he stated. "This is not a mistake. It is a technique on the a part of these dangerous actors to keep away from scrutiny."

What occurred in California shouldn't be distinctive, however the scope of it's. Ghost sufferers, sham firms, offshore homeowners and corrupt docs. Los Angeles County alone has 1,923 hospice suppliers. That is greater than 36 states mixed and 33 instances greater than both Florida's 58 or New York's 40.

"Eighteen p.c of the entire nation's residence healthcare billing is popping out of Los Angeles County," says Dr. Mehmet Oz, head of the Facilities for Medicare and Medicaid Providers. "How is that potential?"

Facilities for Medicare and Medicaid Providers (CMS) Administrator Mehmet Oz questioned how almost one-fifth of the nation's residence healthcare billing is popping out of Los Angeles County. (Nikos DeGruccio/Fox Information Digital)

The fraud in L.A. additionally caught the eye of Congresswoman Claudia Tenney of New York, who wrote Oz in November asking for an investigation into suppliers linked to Dr. Faustina's 10-digit supplier quantity.

"Between 2021 and 2024, residence well being companies linked to this doctor, who lives outdoors of California and is of their 80s, billed almost $600 million to Medicare, together with almost $210 million in 2024 alone, a 124 p.c improve from 2021, with 95 p.c of these funds concentrated in Los Angeles County. Beneficiary affected person rely rose from 9,693 in 2021 to 29,527 for residence well being companies related to this doctor."

"Moreover, a evaluation of different residence well being and hospice applications registered on the similar addresses as these tied to this doctor exhibits over 550 residence well being companies and greater than 250 hospices lively in Medicare, together with the infamous handle in Van Nuys, lengthy flagged by regulation enforcement for Medicare and Medicaid fraud."

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Fox Information obtained the supply paperwork used to assist Tenney's letter and shared the information with Faustina, a vivid and energetic doctor who graduated from medical college in 1963. His main residence is in Las Vegas, however he agreed to speak with us at an condo within the Van Nuys neighborhood of Los Angeles.

"[Congresswoman] Tenney claims your nationwide supplier quantity has been used to invoice Medicare for $600 million and in some way you are answerable for 29,000," I requested. "How can that be?"

"I do not know them (suppliers utilizing his Medicare quantity)," Faustina stated. "I do not do the billing. I've by no means billed Medicare for any of those sufferers. I am given $3,000 a month from this residence healthcare company."

"I am not seeing anyone now. Final month I noticed about ten or fifteen charts after I would go to, however that is sooner or later per week."

The case additionally piqued the eye of Rep. Claudia Tenney, R-N.Y. (Anna Moneymaker/Getty Photos)

But, federal information present 76,000 claims have been filed on behalf of 1000's of sufferers. Information additionally hyperlink him to 18 hospice suppliers, which he denies.

"I'm not related to any hospice," he stated.

We visited a number of hospices utilizing Faustina's Medicare quantity. Many regarded extra like mail drops than medical places of work. A number of have been in run down or largely empty buildings. Nobody answered the door and telephone numbers went to voicemail. Some names had been ripped off the foyer marquee, however have been nonetheless billing Medicare from that handle.

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One handle in Van Nuys contained greater than 100 hospice or residence healthcare companies, but I walked by means of all three flooring and did not see a single affected person, member of the family, physician, nurse or administrator. The outside of the constructing had no signage indicating a supplier was inside, and also you needed to get buzzed in by the constructing supervisor to enter.

At one other location, an company that employed Dr. Faustina on a part-time foundation stated it lower ties after studying Medicare had suspended his billing privileges.