The Los Angeles County Board of Supervisors voted Tuesday to strengthen oversight and enforcement against fraud in the home health and hospice industry, advancing a motion that calls for greater coordination between local, state and federal agencies as prosecutors describe Southern California as the epicenter of a national crisis in Medicare fraud.
The motion, introduced by Supervisors Lindsey P. Horvath and Kathryn Barger, directs the county Department of Public Health to report back with recommendations to improve investigative coordination across government jurisdictions. It also calls on the county to formally urge Sacramento and Washington to strengthen oversight and increase enforcement efforts against accrediting organizations responsible for monitoring the majority of providers.
"Fraud in home health and hospice care is not just a financial crime — it is a direct threat to the health and safety of some of our most vulnerable residents," Horvath said. "Los Angeles County is doing our part and will not allow bad actors to exploit gaps in oversight while patients and families are put at risk."
Barger echoed those concerns, describing fraud in the hospice and home health sector as a betrayal of the people who rely on end-of-life services.
"Hospice and home health care exist to serve our most vulnerable residents, so fraud in these industries is a profound betrayal of their trust," Barger said. "We must work toward stronger coordination and accountability at every level of government."
The board's action comes as Los Angeles County grapples with a staggering concentration of providers. More than 4,700 home health and hospice agencies currently operate in the county — a figure that has grown dramatically in recent years and that federal officials say has made Southern California a high-risk environment for fraud.
State Builds Years-Long Enforcement Record
State officials say California has been ahead of the problem for years. Sen. Ben Allen, D-Santa Monica, praised recent enforcement actions by Gov. Gavin Newsom and Attorney General Rob Bonta, noting that more than 280 fraudulent providers have been shut down statewide.
Allen authored SB 664 in 2021, which established a first-in-the-nation moratorium on new hospice licenses in response to growing concerns about fraud and abuse. He also co-authored AB 2673 in 2022, which closed additional loopholes and updated enforcement tools to keep pace with evolving fraud tactics.
"These policies allowed us to hit pause on a system that was being exploited and gave us needed tools to stay ahead of the fraud," Allen said.
Newsom's office said the state has revoked more than 280 hospice licenses over the past two years, has approximately 300 additional providers under evaluation for revocation, and has arrested 284 individuals in connection with hospice-related offenses since 2019. The California Department of Justice has investigated 101 criminal enterprises and filed 24 civil cases, with 109 individuals charged with hospice-related offenses since 2021.
The state's response has been coordinated through a multi-agency Hospice Fraud Task Force facilitated by the California Department of Public Health, which includes representatives from the California Health and Human Services Agency, Department of Health Care Services, Department of Social Services and the California Department of Justice's Division of Medi-Cal Fraud and Elder Abuse.
Scale of the Problem
The numbers underlying the county's action are stark. Los Angeles County accounts for roughly 18% of all hospice and home health Medicare billing nationwide, despite representing approximately 2.5% of the country's senior population, according to Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz. The county's hospice provider count surged roughly 1,500% from 2010 to 2022 — six times the national growth rate. Average Medicare billing per hospice patient in L.A. County runs about $29,000, more than double the national average of $13,200.
Investigators have documented extreme clustering of providers, including 89 hospice companies registered at a single Van Nuys office plaza and 210 agencies concentrated within one square mile of the San Fernando Valley. A CBS News analysis found more than 700 L.A. County hospice agencies triggered multiple fraud red flags.
Common fraud patterns include paying recruiters $1,000 to $3,000 per Medicare beneficiary number, offering patients cash and gifts to enroll, billing for services never delivered and cycling patients between affiliated hospices to evade audits.
A structural flaw in Medicare's payment system has contributed to the problem. The program pays hospices a flat per diem rate for each day a patient is enrolled, regardless of services actually delivered — a structure the HHS inspector general has said creates incentives to enroll patients who are not terminally ill while minimizing actual care.
Federal Agencies Escalate, Political Battle Lines Sharpen
Federal enforcement has escalated sharply. The Justice Department's June 2025 national health care fraud takedown was the largest in history, with 324 defendants charged across 50 federal districts and $14.6 billion in alleged losses.
In April 2026, the FBI conducted raids across Southern California in an operation called "Operation Never Say Die," charging 15 defendants in nine investigations alleging more than $50 million in fraudulent hospice billing. The operation was coordinated with a fraud task force established by executive order in March 2026 under Vice President JD Vance.
The enforcement surge has also generated political friction. House Oversight Chairman James Comer and more than two dozen Republican members sent a letter to Newsom in March 2026 demanding documents on the state's hospice oversight, calling California a "kingdom of fraud." Oz said his agency had accomplished more in 10 weeks than Newsom had in four years. Newsom's office pushed back, pointing to the 2021 moratorium and accusing the administration of racial profiling after Oz attributed much of the fraud to what he described as an "Armenian mafia."
Recent Prosecutions
Among those charged in the April federal operation was Lolita Beronilla Minerd, 65, of Anaheim, a licensed vocational nurse who allegedly submitted more than $9.1 million in fraudulent hospice claims to Medicare through her Artesia-based Topanga Hospice Care Inc. Investigators said the facility had a non-death discharge rate of approximately 85%, nearly five times the national average, and that Minerd paid cash kickbacks of $300 per month to patients who were not terminally ill.
A Glendale couple, psychologist Gladwin Gill, 66, and his registered nurse wife Amelou Gill, 70, were also arrested and charged with submitting more than $5.2 million in fraudulent claims through their St. Francis Palliative Care facility, of which Medicare paid more than $4 million. Prosecutors alleged the pair laundered proceeds to cover personal expenses including international flights and car payments.
Also charged was Nita Almuete Paddit Palma, 76, described in court documents as a thrice-convicted health care fraudster who allegedly continued operating three fraudulent Glendale-area hospice facilities while incarcerated at a federal prison in Seattle awaiting sentencing on prior charges.
All defendants are presumed innocent until proven guilty.
The Associated Press contributed background information to this report.