DOJ Accuses Healthcare Workers of Falsely Declaring Dementia Patient’s Terminal Status to Exploit Hospice Benefits

A senior resident of California suffering from dementia, who visited the hospital due to abdominal pain and constipation caused by a “fecal mass” in his colon, was reportedly placed in hospice care despite being in good health after his hospital visit, according to the Department of Justice.

The hospice company 626 Hospice Inc., operating under the name St. Francis Palliative Care in Glendale, allegedly fabricated the man’s medical condition, falsely claiming he was terminally ill to exploit Medicare benefits.

Gladwin Gill, aged 66, and his spouse, Amelou Gill, aged 70, the owners and operators of the hospice, are facing federal charges. They, along with other hospice operators in the Los Angeles region, have been accused of billing Medicare for services to patients who were not actually terminally ill, as detailed in court documents submitted by the Justice Department.

These fraudulent activities allegedly amassed over $50 million from Medicare payments.

According to a federal complaint accessed by Law&Crime, some patients were unaware that they had been placed in hospice care. The complaint, filed against 626 Hospice, alleges that the company enrolled and repeatedly re-enrolled individuals without informing them that they were supposedly diagnosed with a terminal condition necessitating palliative care, despite never being told they had less than six months to live.

One patient, identified in the complaint as V.J., had Alzheimer’s disease and was 95 years old, but no doctor or nurse ever told him he was dying, according to the DOJ.

“V.J. was a Kaiser Permanente patient, and had recently beaten prostate cancer and an aneurysm,” the complaint says. “[The man’s daughter] could not recall how V.J. had ended up receiving services from St. Francis Palliative Care.”

According to his primary care doctor, V.J. was “presented at the hospital with abdominal pain” on May 28, 2020, which led to a brief stay, the complaint says. “It was ultimately determined he had a fecal mass in his colon, but no further diagnosis was made and he appeared to feel well after his hospital trip,” the complaint explains.

“[V.J.’s doctor] had never diagnosed V.J. with six months or less to live, nor had she referred him to hospice or palliative care,” the document adds.

Investigators reviewed a copy of V.J.’s medical file, as provided by Kaiser Permanente, and allegedly found an initial referral for a consult to palliative care in August 2019 that was made by a “palliative social worker” sent by 626 Hospice. But upon follow up by the evaluating nurse, V.J. was deemed “fine and did not need palliative care,” according to the complaint. Records show that his family also stated that he did not need palliative care.

Unbeknownst to V.J. and his doctor, 626 Hospice had been enrolling and re-enrolling the man into its palliative care system since May 2018, nearly 16 months prior to “any mention” of hospice services being needed and then declined.

In his file, it was alleged that a doctor referred V.J. for an inpatient palliative care consultation after his 2020 hospital stay for the following reason: “94 yo man dementia, colon mass, daughter ready for home pall, dnr / dni.”

V.J.’s family, however, told federal investigators that he “had never been seen by a doctor with St. Francis,” per the complaint.

“[V.J.’s daughter] could not recall how V.J. had ended up receiving services from St. Francis Palliative Care,” the complaint says. “She described them as ‘okay’ but stated she got irritated when they did not show up when they were supposed to. [The daughter] also stated they do not provide all of the services she saw on the bill to Medicare.”

Federal prosecutors say V.J. is just one of countless patients who were used to “defraud the nation’s health care system out of more than $50 million.” Some were allegedly paid to participate, while others had no idea they were being declared as terminally ill.

A former 626 Hospice employee told the DOJ that one patient’s family member “complained because the patient signed the hospice consent form and it was not explained to the patient that he had six months or less to live,” according to the Gill complaint.

One woman, identified as H.G., was allegedly visited by nurses from 626 Hospice who checked her sugar levels, cholesterol and blood pressure. “H.G. said 626 Hospice also sent a social worker to see her, and she had the name and number of a nurse to call when she needed medicine,” the complaint recounts. “626 Hospice stopped visiting her home in mid-February 2021. H.G. said no one had ever told her that she had a terminal diagnosis or that she had six months or less to live. H.G. had seen a cardiologist for chest pain and the cardiologist told her that she did not have a serious condition.”

A patient identified as T.U., who was also listed by 626 Hospice as needing palliative care, told federal investigators he had previously been told “a long time ago he had six months to live and had previously been on hospice, but laughed and said it was a long time ago and he was still alive,” per the complaint.

Gladwin Gill, who is reportedly a psychologist, and his wife, who is a registered nurse, are both charged with health care fraud and scheduled to appear at a preliminary hearing on April 23.

“They schemed to defraud the nation’s health care system out of more than $50 million — including by running sham hospice care facilities that bilked Medicare by using people without terminal illnesses as beneficiaries,” the DOJ said in a press release announcing the arrests, which came as part of “Operation Never Say Die,” per the department.

“We are enforcing a zero-tolerance policy for criminals who defraud American taxpayers,” said First Assistant United States Attorney Bill Essayli. “The defendants arrested … are charged with stealing millions of dollars of health care benefits … and now face years in federal prison.”