LOS ANGELES
A Ventura County physician who worked for two Pasadena hospices pleaded guilty Thursday to defrauding Medicare out of more than $3 million by billing the public health insurance program for medically unnecessary hospice services, officials stated.
Dr. Victor Contreras, 68, of Santa Paula, pleaded guilty to one count of healthcare fraud. He is facing up to 10 years in federal prison. Contreras’ co-defendant remains at large.
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 claim 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 patient’s primary care physician and had not spoken to those primary care physicians about the patient’s condition.
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 approximately $3,289,889 was paid.
According to Medical Board of California records, Contreras is a licensed physician in California. However, he has been on probation with the Board since 2015 and is subject to limitations on his practice.
U.S. District Judge André Birotte Jr. scheduled an Oct. 25 sentencing hearing. At that hearing, 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.
The U.S. Department of Health and Human Services Office of Inspector General, the FBI, and the California Department of Justice investigated this matter.
Assistant U.S. Attorneys Kristen A. Williams of the Major Frauds Section and Aylin Kuzucan of the General Crimes Section are prosecuting this case.