LA hospice fraud

Question

Hospital is definitely aware that waiver for release of patient's records to thirds party as condition for health services is unenforceable.  
But hospital apparently would not have track record of fraudulent intent of third party, that fraudulently referred patient to hospice with terminal disease that is NOT within expertise of that third party. 
Non-existent terminal disease was recorded at hospital, on admission to hospital, by physician who referred patient to hospital not covered by patient's insurance, and who knew that prior to admission to hospital patient was not terminally ill. 
Is hospital liable for fraud practice?

James L. Arrasmith · Answer

Based on the information provided, there are a few key legal issues to consider under California law regarding potential hospice fraud and hospital liability: 
 
1. Waiver of patient record release: As you noted, under California law, a hospital cannot make the release of patient records to a third party a condition of providing health services. Such a waiver would be considered unenforceable.  
 
2. Fraudulent referral to hospice: If a third party (e.g. a physician) fraudulently referred a patient to hospice care by falsely claiming the patient had a terminal illness that the third party was not qualified to diagnose, this could potentially constitute hospice fraud. Knowingly falsifying a diagnosis to inappropriately refer a patient to hospice would be unlawful. 
 
3. Hospital's knowledge and liability: The key question is whether the hospital knew, or should reasonably have known, about the fraudulent nature of the referral and diagnosis. If the fraudulent diagnosis was recorded at the hospital upon admission by the referring physician, and the hospital relied upon that without reason to doubt it, the hospital may be able to argue it lacked knowledge of the fraud.  
 
However, if there were red flags the hospital ignored (e.g. the referring physician lacking relevant expertise, inconsistencies in records, the patient not appearing terminal, etc.), then the hospital could potentially face some liability for enabling the fraud, even if it denies direct knowledge. Hospitals have certain obligations to exercise due diligence. 
 
4. Insurance issues: The fact the referring physician referred the patient to a hospital not covered by their insurance is also concerning, as it suggests potential improper financial motives. This could bolster a case that the referral was fraudulent. 
 
In summary, while more specific details would be needed to fully assess the situation, based on the information provided, it seems the referring physician's actions are highly questionable and likely fraudulent, but the hospital's liability would depend on what it knew or should have known, and whether it had reason to doubt the diagnosis it relied upon. A thorough investigation into the circumstances and the hospital's processes would be required to determine potential liability. Consultation with a qualified attorney specializing in healthcare fraud would be advisable.

Q: LA hospice fraud