House Republicans are pressing the Department of Health and Human Services' top watchdog to investigate what they describe as large-scale Medicare fraud in California that they say resembles major taxpayer-funded healthcare theft schemes elsewhere.
Leaders on the House Energy and Commerce Committee, working with the House Ways and Means Committee, have sent a letter to HHS Inspector General T. March Bell seeking details on what his office is doing to address concerns that scammers in Los Angeles County are allegedly stealing millions from Medicare through home health and hospice operations.
The letter pointed to prior findings from California's state auditor and other reports suggesting organized fraud tied to a surge of hospice agencies in Los Angeles County.
A state audit has warned that indicators "strongly suggest"networks of perpetrators have been engaged in a large, organized effort to defraud Medicare and Medi-Cal hospice programs in the county.
Among the warning signs cited in that audit were rapid growth in hospice providers, heavy clustering of agencies, long hospice service durations, high rates of patients discharged alive, and employees working for numerous agencies.
In one example, the audit identified 112 licensed hospice agencies listed at the same address in Van Nuys, California, and estimated Los Angeles County hospices likely overbilled Medicare by $105 million in 2019 alone.
The lawmakers also highlighted trends in home health services. The Medicare Payment Advisory Commission reported that the number of home health agencies participating in Medicare rose 3.4% in 2023, but said that increase was due almost entirely to growth in Los Angeles County.
Excluding the county, participating agencies declined 2.8%.
Rep. Brett Guthrie, R-Ky., Energy and Commerce Committee chair, along with fellow GOP Reps. John Joyce of Pennsylvania and Morgan Griffith of Virginia, said in a joint statement that the oversight request reflects Republicans' push to eliminate waste, fraud, and abuse in federal health care programs.
"The House Committee on Energy and Commerce has an extensive history of digging deeper into matters where program integrity has been compromised," they said.
"Republicans have spent much of this Congress furthering legislation to protect our most vulnerable Americans — especially seniors, but our work is not done," they added. "Continued oversight is crucial to uphold the integrity of programs that serve our most vulnerable populations."
House Ways and Means Committee Chair Jason Smith, R-Mo., said Medicare home health and hospice fraud undermines care for older Americans and cited improper-payment and suspected-fraud figures in urging scrutiny.
The Republicans requested a meeting with the inspector general's office by Jan. 23 to discuss evidence they say points to massive Medicare fraud in Los Angeles County and to review recommendations to stop ongoing or future schemes.