Q: In respect to hospice fraudulent referrals.

A: Under California law, there have been several notable cases related to hospice fraudulent referrals and schemes.

In California, it is illegal for hospices to pay kickbacks or engage in other fraudulent practices to induce referrals of patients. The California Insurance Frauds Prevention Act (IFPA) and the federal Anti-Kickback Statute (AKS) prohibit offering, paying, soliciting, or receiving any form of remuneration to induce referrals of patients covered by Medicare, Medicaid, or other federal healthcare programs.

Seminal cases in this area have established that:

1. Hospices cannot pay physicians, nursing homes, or other healthcare providers for patient referrals. This includes direct payments, gifts, or other forms of remuneration.

2. Hospices cannot engage in "reverse false claims" by falsely certifying that patients are terminally ill and eligible for hospice care when they are not, in order to receive Medicare or Medicaid reimbursement.

3. Hospices cannot engage in "kickback" schemes where they pay bonuses or other incentives to their own employees for reaching certain patient enrollment targets or quotas.

4. Whistleblowers who report hospice fraud under the False Claims Act can receive a percentage of any recovered damages.

Penalties for violating the IFPA and AKS can include substantial fines, exclusion from federal healthcare programs, and even criminal charges in severe cases.

These principles have been established and reinforced through various cases prosecuted by the California Department of Justice and the U.S. Department of Justice. The specific facts and legal issues vary between cases, but the goal is to protect patients and public healthcare funds from fraud and abuse by unscrupulous hospice providers.