On May 6th, 2016

Two Doctors Convicted in $8.8 Million Healthcare Fraud Scheme

csleaLOS ANGELES – On May 5, 2016, a jury found guilty, two doctors who participated in an elaborate healthcare scheme in which patients were classified as dying and in need of hospice care, when in fact they were not.  The doctors were convicted on federal healthcare fraud charges and now face years in prison.

" The California Department of Justice Bureau of Medi-Cal Fraud & Elder Abuse assisted federal agents and investigators with this lengthy case and to date, two doctors have been found guilty after a two-week trial, and four other defendants  have pleaded guilty," said California Statewide Law Enforcement Association (CSLEA) President Alan Barcelona.  "It is absolutely appalling that so-called healthcare professionals would put profit over patient and bilk public healthcare programs and taxpayers out of millions of dollars."

The two doctors, Sri Wijegoonaratna, known as Dr. J., 61, of Anaheim, and Boyao Huang, 43, of Pasadena, participated in a scheme involving  the 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.   The two public health programs paid nearly $7.4 million to CHC.

“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.”

Wijegoonaratna, was found guilty of seven counts of health care fraud and Huang was found guilty of four counts of health care fraud.  They two are scheduled to be sentenced on August 15, 2016 and fac a statutory maximum sentence of 10 years in federal prison for each count.

As for the four other defendants who pleaded guilty, three await sentencing while the fourt has been accepted into a diversion program.   One of those defendants,  a Placentia woman, 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 on June 20.

As part of the CHC fraud scheme, Villabroza and her daughter – who was 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 Department of Justice  Bureau of Medi-Cal Fraud & Elder Abuse; and IRS Criminal Investigation.

 

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