Doctor denies knowing about rampant LA-area Medicare fraud using his provider number

On a busy, gritty thoroughfare successful suburban Los Angeles, the achromatic one-story stucco gathering looked similar immoderate other. Among the apartments, offices, sidewalk bodegas, the lone defining diagnostic was the building's doorway – a thick, coagulated slab of acheronian oak with a small, information grill astir six inches square.

"Is Dr. Faustina here," I asked. "This is his code of grounds with the aesculapian board."

 A look appeared successful the cutout, "He doesn't enactment here."

That's odd, I thought, considering aggregate location healthcare agencies astatine this code had billed Medicare much than $40 cardinal dollars utilizing 87-year-old Dr. Gilbert Faustina's Medicare number, according to national records.

LOS ANGELES COUNTY FACES SCRUTINY AFTER ALLEGED WIDESPREAD HOSPICE FRAUD EXPOSED

Healthcare fraud is reportedly a large concern successful Los Angeles. (Myung J. Chun / Los Angeles Times via Getty Images)

Yet arsenic aggregate authorities and national audits person shown, healthcare fraud successful Los Angeles is large business, with payer losses estimated astatine $3.5 billion.

Lawmakers connected Capitol Hill are demanding national inspectors workout stronger oversight to combat what they telephone "large standard fraud" with patients receiving inappropriate oregon nonexistent care, with doctors signing disconnected connected diligent attraction plans  having ne'er met the patient, and hospice and location wellness providers utilizing aggregate licenses to 'shuffle' patients from 1 bureau to different to flight authorities and national audits.

Dr. Ira Byock, a nationalist adept connected location healthcare and the writer of respective books, describes however the ammunition crippled works.

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"You'll person 3 oregon 4 oregon 10 of them operating retired of a azygous address, with antithetic names and antithetic licenses, but they're each lone serving a fewer patients which keeps them astatine a level nether the radar of the Medicare's criteria for serving hospice programs," helium said. "This isn't a mistake. This is simply a strategy connected the portion of these atrocious actors to debar scrutiny."

What happened successful California is not unique, but the scope of it is. Ghost patients, sham companies, offshore owners and corrupt doctors. Los Angeles County unsocial has 1,923 hospice providers. That's much than 36 states combined and 33 times much than either Florida's 58 oregon New York's 40.

"Eighteen percent of the full country's location healthcare billing is coming retired of Los Angeles County," says Dr. Mehmet Oz, caput of the Centers for Medicare and Medicaid Services. "How is that possible?"

Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz questioned however astir one-fifth of the country's location healthcare billing is coming retired of Los Angeles County. (Nikos DeGruccio/Fox News Digital)

The fraud successful L.A. besides caught the attraction of Congresswoman Claudia Tenney of New York, who wrote Oz successful November asking for an probe into providers linked to Dr. Faustina's 10-digit supplier number.

"Between 2021 and 2024, location wellness agencies linked to this physician, who lives extracurricular of California and is successful their 80s, billed astir $600 cardinal to Medicare, including astir $210 cardinal successful 2024 alone, a 124 percent summation from 2021, with 95 percent of those payments concentrated successful Los Angeles County. Beneficiary diligent number roseate from 9,693 successful 2021 to 29,527 for location wellness agencies associated with this physician."

"Furthermore, a reappraisal of different location wellness and hospice programs registered astatine the aforesaid addresses arsenic those tied to this doc shows implicit 550 location wellness agencies and much than 250 hospices progressive successful Medicare, including the notorious code successful Van Nuys, agelong flagged by instrumentality enforcement for Medicare and Medicaid fraud."

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Fox News obtained the root documents utilized to enactment Tenney's missive and shared the records with Faustina, a agleam and energetic doc who graduated from aesculapian schoolhouse successful 1963. His superior residence is successful Las Vegas, but helium agreed to speech with america astatine an flat successful the Van Nuys vicinity of Los Angeles.

"[Congresswoman] Tenney claims your nationalist supplier fig has been utilized to measure Medicare for $600 cardinal and someway you're liable for 29,000," I asked. "How tin that be?"

"I don't cognize them (providers utilizing his Medicare number)," Faustina said. "I don't bash the billing. I've ne'er billed Medicare for immoderate of these patients. I'm fixed $3,000 a period from this location healthcare agency."

"I'm not seeing anybody now. Last period I saw astir 10 oregon 15 charts erstwhile I would visit, but that's 1 time a week."

The lawsuit besides piqued the attraction of Rep. Claudia Tenney, R-N.Y. (Anna Moneymaker/Getty Images)

Yet, national records amusement 76,000 claims were filed connected behalf of thousands of patients. Records besides nexus him to 18 hospice providers, which helium denies.

"I americium not associated with immoderate hospice," helium said.

We visited respective hospices utilizing Faustina's Medicare number. Many looked much similar message drops than aesculapian offices. Several were successful tally down oregon mostly bare buildings. No 1 answered the doorway and telephone numbers went to voicemail. Some names had been ripped disconnected the lobby marquee, but were inactive billing Medicare from that address.

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One code successful Van Nuys contained much than 100 hospice oregon location healthcare agencies, yet I walked done each 3 floors and didn't spot a azygous patient, household member, doctor, caregiver oregon administrator. The exterior of the gathering had nary signage indicating a supplier was inside, and you had to get buzzed successful by the gathering manager to enter.

At different location, an bureau that hired Dr. Faustina connected a part-time ground said it chopped ties aft learning Medicare had suspended his billing privileges. 

So bash you deliberation somebody's astir apt committing fraud connected your behalf?" I asked Faustina.

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"Absolutely," helium said. "Not connected my behalf, connected their behalf."