LA hospice fraud

Question

actual hospice fraud was chain of actions by provider, hospital, and undisclosed likely  third party. 
Actions include non-existent terminal diagnosis, unauthorized disclosure of records to undisclosed party.  
How defendant hospital will prove unintentional chain of unfortunate events? 
(Hospital's records without referencing disclosure of records, but with records of unenforceable waiver for release of records,  records of non-existent referrals were verified by risk management officer). 
Usually something like: referral to hospice with non-existent terminal disease recorded? (That would be Direct evidence)

James L. Arrasmith · Answer

This situation involving potential hospice fraud in Los Angeles raises several complex legal issues. Based on the details provided, here are a few key considerations: 
 
Proving Unintentional Acts: The hospital will likely try to argue that the chain of events, while unfortunate, was unintentional rather than a deliberate scheme to commit fraud. They may claim that errors or miscommunications led to inaccurate records and improper disclosures, rather than willful fraud. The strength of this argument will depend on the specific evidence. 
 
Unauthorized Disclosure of Records: The unauthorized disclosure of medical records to an undisclosed third party is a serious breach of patient privacy laws like HIPAA. The hospital would need to show this disclosure was accidental or somehow justified. The "unenforceable waiver" for record release could be a key piece of evidence - the hospital may argue the patient consented even if the waiver is invalid. 
 
Hospice Referral and Diagnosis: Referring a patient to hospice care without a valid terminal diagnosis could constitute fraud, as hospice is intended only for terminally ill patients. If records show a referral and hospice admission without proper medical basis, that is strong evidence of potential fraud. The hospital would need to prove the patient did have a terminal condition warranting hospice. 
 
Record Verification: The fact that inaccurate records of non-existent referrals were verified by the hospital's risk management raises red flags. The hospital would need to explain how and why clearly erroneous records were validated by an internal oversight process.  
 
While the hospital may try to portray this as an unintentional series of mistakes, the unauthorized disclosures, invalid hospice referral, and verification of inaccurate records point to potential systemic issues and fraud. Strong, direct evidence like records of a hospice referral without proper medical basis would bolster a fraud case. 
 
However, more details and evidence would be needed to fully assess the situation and the hospital's potential defenses. Consulting with an attorney specializing in healthcare fraud and abuse cases is strongly advised for anyone pursuing or facing allegations of this nature. They can review all the facts and advise on the best course of action.

Q: LA hospice fraud