In the United States, there have been a series of major cases of fraud in end-of-life care (also known as hospice care) and daytime care revealed since last year. Chinese doctors in Southern California pointed out that this fraud has been going on for years, and if relevant organizations strengthen their supervision slightly, the illegal activities would significantly decrease.
Los Angeles Diamond Bar City Councilor and senior family physician Dr. Deng Jiayou recently stated in an interview that ten years ago, many patients told him that someone was asking for their medical card information to claim certain benefits. These patients also received perks like free nutritional supplements, cash rebates, and so on.
“Some patients felt uneasy after receiving these so-called benefits and came to tell me about it. At that time, I advised them not to take these things,” Deng Jiayou said. He was surprised to hear about these incidents and wondered why the government did not investigate.
Deng Jiayou believes that the government’s lack of supervision over end-of-life care facilities has led to a high number of cases of service misuse. Many of these organizations, upon establishment, immediately start collecting elderly individuals’ Medicare cards, Medicaid cards, and other information to create false service records, bill the government for subsidies, and then give some cash kickbacks to these elderly individuals.
“I have been practicing medicine for so many years, and I think there was simply no oversight before. Anyone could start a company to do these things, falsify patient information, and easily get paid by the government,” he said.
Some elderly individuals are completely unaware of these activities. Especially before the year-end, some people, posing as insurance brokers, obtain the elderly’s insurance information and add them to the list of end-of-life care facilities. Many Chinese elderly individuals, due to language barriers, are more vulnerable to becoming victims of medical insurance fraud.
Recently, the California Inquirer reported that after an elderly individual was registered for end-of-life care services, Medicare (commonly known as the red, white, and blue card) cut off some reimbursement items listed in their medical insurance because the insurance company believed that elderly individuals in hospice care no longer needed certain diagnostic services. After several months of communication, Medicare confirmed that this elderly person was a victim of Medicare fraud.
Before 2020, to establish an end-of-life care company in California, one needed to provide a lease agreement, establish operational, managerial, and clinical procedures, recruit core staff, and then submit preliminary application materials to the California Department of Health for state licensing and certification. Upon approval, they could apply for certification from Medicare and the Medi-Cal program in California (commonly known as the white card).
After 2020, the California government received a large number of fraud reports, prompting the implementation of a stricter licensing issuance system.
“End-of-life care facilities contact some doctors and have them issue certificates randomly, stating that the person has a serious illness and needs end-of-life care; it is very easy to obtain false certificates,” Deng Jiayou said. “When a patient has a severe illness, they usually would not only see one doctor but multiple doctors, undergo many diagnoses, and in severe cases, be hospitalized before a doctor issues an end-of-life care certificate.”
He also pointed out that investigating fraud is straightforward: first, cross-reference data to check the validity of diagnoses. Second, send people for field visits, talk to patients, and verify if they indeed have the stated illnesses; this can be confirmed immediately, “but these things were not done in the past.”
Furthermore, if a medical insurance organization notices that a particular doctor suddenly has a large number of patients requiring end-of-life care, or if they find that the percentage of end-of-life care patients in an area is significantly higher than the statewide or national average, they can conduct inquiries and quickly uncover any discrepancies.
Deng Jiayou emphasized that California bears responsibility for the rampant medical fraud, as do federal regulatory agencies, because even the federal red, white, and blue cards have been widely abused. He admired Elon Musk’s efficient analysis across various federal departments using big data last year and detecting a large amount of fund misuse. “Utilizing big data analysis makes it easy to uncover these issues and can save a lot of manpower.”
Finally, Deng Jiayou stated that end-of-life care services have indeed helped many families, and by weeding out problematic companies, legitimate businesses can operate better and provide better services to patients. “Eliminating companies that abuse benefits and commit fraud is also good news for families who genuinely need to access these benefits,” he said. ◇