Q: Legal theories. Improper referrals.

A: Under California law, improper referrals to hospice that are fraudulent could potentially give rise to claims of fraud against the hospital and breach of fiduciary duty against the referring doctor. Here are some key legal considerations:

Fraud by Hospital:

- Fraud requires a misrepresentation of material fact, knowledge of falsity, intent to deceive, justifiable reliance, and resulting damages.

- If the hospital knowingly made false representations about the patient's condition or eligibility for hospice to induce the patient to agree to hospice care, when hospice was not medically appropriate, this could constitute fraud.

- Specific false statements and evidence of fraudulent intent would need to be proven.

Breach of Fiduciary Duty by Doctor:

- Doctors owe a fiduciary duty to act in the best interests of their patients and adhere to the standard of care.

- Improperly referring a patient to hospice, if the doctor knows or should know hospice is not appropriate, could be a breach of this duty of care and loyalty to the patient.

- It would need to be shown the referral deviated from the standard of care and was not in the patient's best interests.

Other Potential Theories:

- Medical negligence/malpractice if the improper referral fell below the standard of care and caused harm

- Financial elder abuse if an improper referral was made for financial gain at the expense of an elderly patient

Of course, the viability of any legal claims depends heavily on the specific facts - the patient's actual medical condition, what statements were made, the doctor's reasoning behind the referral, any kickbacks or financial incentives, the resulting harm to the patient, etc. Expert medical opinion is usually required as well.

But in general, knowingly false or improper referrals to hospice could support fraud and breach of fiduciary duty theories against the hospital and doctor if the key elements can be proven. Careful analysis of all case facts would be needed to evaluate the strength of potential legal claims under California law.