LOS ANGELES
A Ventura County physician who worked for
Pasadena hospices was sentenced Monday to 24 months in federal prison for defrauding Medicare out of more than $3 million through claims for medically unnecessary hospice services, officials stated.
Dr. Victor Contreras, 69, of Santa Paula, was sentenced by U.S. District Judge André Birotte Jr., who also ordered him to pay $3.2 million in restitution.
Contreras pleaded guilty on July 24 to one count of health care fraud.
From July 2016 to February 2019, Contreras and co-defendant Juanita Antenor, 62, 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, according to officials.
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.
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 $3.9 million in fraudulently 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.
Antenor remains at large.
Co-defendant Callie Black, 66, of Lancaster, who allegedly recruited patients for the hospice companies in exchange for illegal kickbacks, has pleaded not guilty and is scheduled to go to trial on March 4.
Defendants are presumed innocent unless proven guilty.
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.