Hospice care and fraud keep turning up together because there is money in the system, and a California woman told lawmakers on Tuesday how that can swallow real patients whole. Her account came days after Sheila Clark warned Congress that California is the clearest current warning sign, but not the only one, in a widening Medicare problem tied to hospice billing and oversight.
The warning lands at a moment when older adults are surging in number and tax dollars are available to pay for care, creating a target-rich environment for scammers and profiteers. Clark said fraud is not just a state scandal but a federal one, and that stolen identities and false billings have been used to place people who are not dying on hospice rolls while legitimate patients are left to sort out the damage.
That is why the testimony carried such force. Another witness at the same hearing said she was denied Medicare coverage for a pickleball injury after scammers stole her identity and enrolled her in hospice coverage, a reminder that the harm can spread far beyond end-of-life care itself. Clark, whose agency has posted guidance on hospice care at a facility or at home, said families should ask whether a provider has a relationship with a personal physician and what is expected of the family caregiver.
California’s own reforms are still a work in progress after a 2020 Los Angeles Times expose by Kim Christensen and Ben Poston laid out problems in the state’s hospice system. Since then, the Trump administration has singled out California for failures in oversight and has also gone after other states, while California officials have pushed back and both sides have pointed to arrests of multiple fraudsters as proof they are acting. The result is a familiar Washington fight: blame travels faster than cleanup.
The fraud accusations also echo outside hospice. Federal prosecutors and regulators have taken on abuse in a range of programs, from cases that have drawn attention in Alabama to visa-related schemes in California, because the same pattern keeps repeating: a benefit program, weak checks, and someone willing to exploit the gap. In hospice, though, the stakes are especially grim because the service is often the right choice and the best choice when it is appropriate.
Santa Clarita geriatrician Dr. Gene Dorio said consumers should ask a lot of questions of their primary care physician, partly because hospitals, insurance companies and doctors have been known to prematurely dump patients into hospice for financial reasons. He said some patients do not get the care they need and pay with their lives. Dorio recalled being asked by a hospice operator to examine a patient who arrived with a diagnosis of bladder cancer; he found no evidence of cancer, and the patient was sent back to regular care.
That is the hard answer to the question hanging over the testimony: the abuse is real, the harm can be immediate, and California is not the only place where it is happening. Clark’s warning, the woman’s account and Dorio’s example point to the same conclusion — hospice fraud is now a Medicare integrity problem that belongs to both Sacramento and Washington, and neither can solve it by blaming the other.