The Office of Inspector General (OIG) joined federal and state law enforcement and announced charges against 455 defendants, including 90 doctors and other medical professionals, for health care fraud and opioid abuse schemes. Defendants included individuals connected with fraudulent claims for amniotic wound allografts driven by a kickback scheme for marketers and medical providers.
The alleged kickbacks caused the targeting of hospice patients and applying the allografts "without coordination with the patients’ treating physicians." In other cases, the skin allografts were never even applied. LeadingAge made clear in comments on the FY2027 Hospice Proposed Rule that any Part B spending on skin allografts (which made up more than 50% of all Part B non-hospice spending) should be removed from the Services and Spending Variation Index non-hospice spending measure due to the overwhelming evidence of fraudulent billing.
Additionally, a hospice owner and employees were charged in a scheme that attempted to avoid detection by purchasing information from funeral home employees and fraudulently enrolling deceased Medicare beneficiaries. The owner allegedly billed Medicare for a few days of hospice services for these recently deceased individuals who had not received hospice care and created fake, back-dated medical records claiming that the beneficiaries had been seen by a physician, thereby allegedly seeking to deceive Medicare by reducing his outlier data metrics on live-discharges.