Lynn Ianni didn’t learn she was apparently dying in a Los Angeles County hospice care facility until her Medicare claim for a pickleball injury was rejected.
“At first we laughed because it was an obvious clerical error,” the Seattle-based psychotherapist recalled before a congressional committee Tuesday, where she was providing testimony about her months-long experience in 2024 with fraud in the hospice industry. “It wasn’t just frustrating, it was terrifying.”
Ianni appeared before the House Ways and Means Committee on Capitol Hill at a hearing that revealed details about fake claims and stolen doctors’ identities. She was a victim of California hospice scammers. Her situation, like many others, occurred despitepromises of reforms from lawmakers five years ago, when widespread corruption in California came to light.
In late 2020, a Times investigationrevealed that a cohort of mostly older Americans was being targeted by unscrupulous providers who would bill Medicare for hospice services and equipment for patients who they said were terminally ill, but who were in fact not dying.
Ianni was denied care for a pickleball-related shoulder injury. Her healthcare provider, she testified, told her that her Medicare would not cover treatment because she was enrolled in hospice. She testified that despite a scammer stealing her Medicare ID number and enrolling her in hospice without her knowledge, she had to continue to pay her premiums if she wanted coverage.
Ianni tracked the hospice facility involved to an enormous strip mall and then tracked down the doctors who signed off on the fake care through their National Provider Identifier — it turned out to be a Santa Monica surgeon whose identity had also been stolen and had “no connection whatsoever to the hospice.”
“Despite uncovering clear evidence of fraud, nothing changed,” she told the committee.
Ianni said she reached out to federal regulators who administer Medicare, and they told her to file an appeal for her denied claims, a process that could take a year or more to resolve. She said that eventually, with the help of an advocacy group, she received a new Medicare card and was able to resume physical therapy.
“It is evidence of systemic failure, one that allows fraud to occur, has been preventing timely correction and leaves vulnerable people without care, without answers and without protection,” Ianni told lawmakers, saying only her medical experience led to her overcoming the problems.
Ianni’s testimony came as the Trump administration has begun focusing its attention on fraud in the state.
When the scope of the state’s fraud first came to light in 2020, one of California’s first moves was to put a moratorium on issuing new hospice licenses to give officials time to strengthen oversight. State officials and industry representatives crafted emergency regulations that they said would address gaps in hospice licensing requirements to weed out bad actors.
But years later, those regulations have still not been enacted. And problems that have plagued the industry persist despite highly publicized enforcement efforts by the state and federal government, experts say.
Since Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, or CMS, and former TV personality, visited L.A. in January, a new aggressive approach has seen 450 hospices in the area suspended from the payment system as part of a task force led by Vice President JD Vance.
While the Trump administration has framed California as the nation’s fraud hot spot, industry leaders told the committee Tuesday the problems are nationwide.
“California is the clearest current warning sign, but this is not simply a California problem. It is a federal Medicare program-integrity problem and a state-federal oversight problem,” testified Sheila Clark, president and chief executive officer of the California Hospice and Palliative Care Assn. “When scammers are allowed to enter the system, remain in the system, and shape the claims and cost report environment used by CMS, beneficiaries and taxpayers across the country bear the consequences.”
“They expose vulnerable people to exploitation, deny them appropriate care, undermine trust in Medicare, and, when left unchecked, distort the data and assumptions federal policymakers rely upon to oversee these benefits.”
Clark warned that scammers, despite a California moratorium on licenses, have continued to thrive.
“The warning signs are familiar: provider clustering at common addresses, rapid enrollment growth in saturated markets, repeated use of the same medical directors or certifying physicians, invalid or unverifiable contact information, exclusive fee-for-service Medicare billing in home health in high Medicare Advantage markets, and billing patterns that diverge sharply from clinical reality,” she said.
She said the Centers for Medicare and Medicaid Services should “use its administrative authorities earlier and more aggressively” to curtail fraud rather than respond after it’s occurred.
The post How a pickleball injury highlights fraud in California’s hospice industry appeared first on Los Angeles Times.
