Two groups of perpetrators are facing justice after allegedly committing hospice fraud.
The California Attorney General’s office has secured the sentencing of two alleged conspirators, Ralph and Rochell Canales, a married couple. Ralph Caneles received a sentence of seven years and four months in prison and payment of nearly $1.5 million in restitution.
Rochell Canales was sentenced to one year in jail and is permanently banned from working with Medicare and Medi-Cal beneficiaries or at any health care organization that receives funds from those programs. Medi-Cal is California’s Medicaid program.
“Medi-Cal and Medicaid exist to serve our most vulnerable communities. They are lifelines, not opportunities for exploitation,” Attorney General Bonta said in a statement.
The Canales operated four hospice companies that submitted false claims between 2013 and 2022 by misrepresenting patient eligibility for hospice care. They also paid illegal kickbacks to marketers and physicians in exchange for referrals and failed to pay corporate taxes.
The scam involved at least 52 patients.
The case is the latest to take place in the four states identified as hotbeds for fraud, California, Nevada, Arizona and Texas.
Meanwhile in Texas, seven women have been charged with defrauding Medicare of more than $100 million associated with hospice beneficiaries.
Hattie Banks, Lydia Obere, Cheryl Brooks and Ena Cowart have been indicted by a federal grand jury. Each faces charges of health care fraud and two felony conspiracy counts related to the fraud scheme and an alleged kickback operation. Banks, Obere and Brooks also face charges for receiving kickbacks.
The indictment also adds charges against three defendants originally charged in June: Dera Ogudo, Victoria Martinez and Evelyn Shaw.
Ogudo and Martinez owned multiple hospices and group homes in Fort Bend County, Texas, including United Palliative & Hospice Care, Cedar Hospice, Residential Hospice, Real Comfort Care and Elizabeth Gardens, according to the indictment.
The defendants allegedly solicited patient referrals from individuals including Shaw, a discharge planner at a Houston-area psychiatric hospital, according to the indictment. Prosecutors allege patients were not terminally ill and often did not understand the care for which they were approved. Shaw and others received kickbacks for the referrals, and Ogudo allegedly bribed a physician to falsify documents making patients appear eligible for treatment.
