Monday, May 9, 2016

Two Doctors Convicted of Falsely Certifying Patients as Terminally Ill as Part of $8.8 Million Healthcare Fraud Scheme

LOS ANGELES – Two doctors were found guilty today of federal health care fraud charges for falsely certifying that Medicare patients were terminally ill, and therefore qualified for hospice care, when the vast majority of them were not actually dying.

Following a two-week trial, the doctors were found guilty of participating in a scheme related to the Covina-based California Hospice Care (CHC). Between March 2009 and June 2013, CHC submitted approximately $8.8 million in fraudulent bills to Medicare and Medi-Cal for hospice-related services, and the public health programs paid nearly $7.4 million to CHC.

The two doctors convicted today by a federal jury are:
  • Sri Wijegoonaratna, known as Dr. J., 61, of Anaheim, who was found guilty of seven counts of health care fraud; and
  • Boyao Huang, 43, of Pasadena, who was found guilty of four counts of health care fraud.
United States District Judge S. James Otero, who presided over the trial, is scheduled to sentence the two defendants on August 15, at which time each will face a statutory maximum sentence of 10 years in federal prison for each count of health care fraud

A number of patients admitted to California Hospice Care testified at trial, showing that they did not require end-of-life care, said United States Attorney Eileen M. Decker.  In fact, only a small percentage of patients later died – notwithstanding the two doctors declaring that they needed hospice care. This scheme is one of many that has victimized public health care programs and, in the end, the taxpayers who fund these important programs. We will continue to investigate these fraudulent schemes, shut down the operations and incarcerate those responsible for stealing from the system. 

Four other defendants who were named in a federal grand jury indictment in September 2014 have pleaded guilty to health care fraud charges and are pending sentencing (except for one defendant who has been accepted into a diversion program). Those other defendants include a Placentia woman who purchased CHC in 2007 and operated the facility after being charged and incarcerated in another health care fraud scheme. Priscilla Villabroza, 70, previously pleaded guilty in December to one count of health care fraud and is scheduled to be sentenced by Judge Otero on June 20.

As part of the CHC fraud scheme, Villabroza and her daughter – who wass the nominal owner while Villabroza was in custody – paid patient recruiters known as "marketers" or "cappers" to bring in Medicare and Medi-Cal beneficiaries. CHC nurses performed "assessments" to determine whether the beneficiaries were terminally ill and, regardless of the outcome, Wijegoonaratna and Huang certified that the beneficiaries were terminally ill – even though the vast majority of them were not dying. CHC personnel altered medical records in response to Medicare audits to make the beneficiaries appear sicker.

The evidence at trial showed that Wijegoonaratna also recruited patients into the scheme and received tens of thousands of dollars in kickbacks. Not only did defendant Wijegoonaratna refer beneficiaries to CHC in exchange for illegal kickbacks, but he also created fraudulent diagnoses and falsely certified that the referred beneficiaries were terminally ill, even though the overwhelming majority of CHC beneficiaries were not terminally ill, so that CHC could qualify for reimbursement from Medicare, prosecutors wrote in court documents filed in relation to the trial. The California Medical Board has revoked Wijegoonaratna's medical license.

By the time the scheme was shut down in June 2013, Medicare and Medi-Cal paid millions of dollars for medically unnecessary hospice-related services.

The investigation into California Hospice was conducted by the United States Department of Health and Human Services, Office of Inspector General; the Federal Bureau of Investigation; the California Bureau of Medi-Cal Fraud & Elder Abuse; and IRS Criminal Investigation.


USAO - California, Central Topic:  Healthcare Fraud