LOS ANGELES—A Ventura County physician who worked for two Pasadena hospices pleaded guilty to defrauding Medicare out of more than $3 million by billing the public health insurance program for medically unnecessary hospice services.
Victor Contreras, 68, of Santa Paula, pleaded guilty to one count of health care fraud.
According to his plea agreement, from July 2016 to February 2019, Contreras and co-defendant Juanita Antenor, 61, formerly of Pasadena, schemed to defraud Medicare by submitting nearly $4 million in false and fraudulent claims for hospice services submitted by two hospice companies: Arcadia Hospice Provider Inc. and Saint Mariam Hospice Inc. Antenor controlled both companies.
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 runs its normal course.
Contreras falsely stated on claims forms that patients had terminal illnesses to make them eligible for hospice services covered by Medicare, typically adopting diagnoses provided to him by hospice employees whether or not they were true. Contreras did so even though he was not the patients’ primary care physician and had not spoken to those primary care physicians about the patients’ conditions. Medicare paid on the claims supported by Contreras’ false evaluations and certifications and recertifications of patients.
In total, approximately $3,917,946 in fraudulent claims were submitted to Medicare, of which a total of approximately $3,289,889 was paid.
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.
United States District Judge André Birotte Jr. scheduled an Oct. 25 sentencing hearing, at which time Contreras will face a statutory maximum sentence of 10 years in federal prison.
Antenor remains at large. Co-defendant Callie Black, 65, of Lancaster, who allegedly recruited patients for the hospice companies in exchange for illegal kickbacks, has pleaded not guilty and is currently scheduled to go on trial on Oct. 15.
An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed to be innocent until and unless proven guilty in court.
