California doctor defrauded Medicare out of $3 million: DOJ
LOS ANGELES - A Southern California physician pleaded guilty Wednesday to defrauding Medicare out of more than $3 million by billing the program for medically unnecessary hospice services, according to the U.S. Department of Justice.
Dr. Victor Contreras, 68, of Santa Paula, and his co-defendant Juanita Antenor, 61, allegedly schemed to defraud Medicare by submitting nearly $4 million in false claims for hospice services submitted by two hospice companies in Pasadena between July 2016 and February 2019, the DOJ said.
According to court documents, Contreras falsely stated on claims forms that patients had terminal illnesses to make them eligible for hospice services covered by Medicare.
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"Medicare only covers hospice services for patients who are terminally ill, meaning that they have a life expectancy of six months or less if their illness ran its normal course," officials said.
Contreras allegedly did this even though he was not the patients' primary care physician and did not speak to those physicians about the patients' conditions, according to court documents.
As a result, Medicare paid the claims supported by Contreras' false evaluations of those patients. Medicare paid approximately $3,289,889 of the $3,917,946 in fraudulent claims submitted by Contreras.
According to Medical Board of California records, Contreras is a licensed physician in California, but has been on probation with the Board since 2015 and is subject to limitations on his practice.
Contreras pleaded guilty to one count of health care fraud. His sentencing hearing is scheduled for Oct. 25. He faces a maximum sentence of 10 years in federal prison.
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Meanwhile, Antenor is still on the run. The former Pasadena resident who controlled the hospices involved is believed to be in the Philippines, according to the DOJ.
Another co-defendant, Callie Black, 65, of Lancaster, who allegedly recruited patients for the hospice companies in exchange for illegal payments, has pleaded not guilty and is currently scheduled to go on trial on October 15.