The government’s intense focus on rooting out fraud in the hospice industry resulted in a California man pleading guilty earlier this week in a $3.1 million Medicare fraud scheme.
The Department of Justice said Karen Sarkisyan — who also went by the name of Kevin Sarkisyan — submitted false and fraudulent forms for San Gabriel Hospital and Palliative Care Inc under the names of a false straw owner and manager. The company submitted more than $3.7 million in false and fraudulent claims to Medicare, of which more than $3.1 million was paid after Sarkisyan submitted the fake enrollment applications.
Sarkisyan pleaded guilty to one count of conspiracy to defraud the United States and is scheduled to be sentenced in September. He faces a maximum penalty of five years in prison. A co-conspirator was previously found guilty of healthcare fraud and is scheduled to be sentenced in August. A third co-conspirator was indicted for his part in the scheme and is at large.
The hospice industry has come under increased scrutiny by the government, provider groups and the media over the past several months over allegations of fraud, abuse and waste. In announcing its proposed 2024 hospice payment rate update late last week, the Centers for Medicare & Medicaid Services said it will require all physicians who order or certify hospice services be enrolled in Medicare or validly opt out as a prerequisite for payment of hospice services. CMS also called for penalties on hospices that fail to meet quality reporting requirements.
The Office of Inspector General and the Government Accountability Office have called for tougher oversight of hospices. Provider groups, such as the National Association for Home Care & Hospice, LeadingAge and the National Hospice and Palliative Care Organization recently urged Congress to toughen up hospice regulations and put a moratorium on the opening of new hospices in certain regions. A handful of states, including Arizona, Texas and California have seen a proliferation of new hospices in recent years.
