Doctor denies knowing about rampant LA-area Medicare fraud using his provider number
On a busy, gritty street in suburban Los Angeles, the white one-story stucco building looked like any other. Among the apartments, offices, sidewalk bodegas, the only defining feature was the building's door – a thick, solid slab of dark oak with a small, security grill about six inches square.
"Is Dr. Faustina here," I asked. "This is his address of record with the medical board."
A face appeared in the cutout, "He doesn't work here."
That's odd, I thought, considering multiple home healthcare agencies at this address had billed Medicare more than $40 million dollars using 87-year-old Dr. Gilbert Faustina's Medicare number, according to federal records.
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Yet as multiple state and federal audits have shown, healthcare fraud in Los Angeles is big business, with taxpayer losses estimated at $3.5 billion.
Lawmakers on Capitol Hill are demanding federal inspectors exercise stronger oversight to combat what they call "large scale fraud" with patients receiving inappropriate or nonexistent care, with doctors signing off on patient care plans having never met the patient, and hospice and home health providers using multiple licenses to 'shuffle' patients from one agency to another to escape state and federal audits.
Dr. Ira Byock, a national expert on home healthcare and the author of several books, describes how the shell game works.
"You'll have three or four or 10 of them operating out of a single address, with different names and different licenses, but they're all only serving a few patients which keeps them at a level under the radar of the Medicare's criteria for serving hospice programs," he said. "This isn't a mistake. This is a strategy on the part of these bad actors to avoid scrutiny."
What happened in California is not unique, but the scope of it is. Ghost patients, sham companies, offshore owners and corrupt doctors. Los Angeles County alone has 1,923 hospice providers. That's more than 36 states combined and 33 times more than either Florida's 58 or New York's 40.
"Eighteen percent of the whole country's home healthcare billing is coming out of Los Angeles County," says Dr. Mehmet Oz, head of the Centers for Medicare and Medicaid Services. "How is that possible?"
The fraud in L.A. also caught the attention of Congresswoman Claudia Tenney of New York, who wrote Oz in November asking for an investigation into providers linked to Dr. Faustina's 10-digit provider number.
"Between 2021 and 2024, home health agencies linked to this physician, who lives outside of California and is in their 80s, billed nearly $600 million to Medicare, including nearly $210 million in 2024 alone, a 124 percent increase from 2021, with 95 percent of those payments concentrated in Los Angeles County. Beneficiary patient count rose from 9,693 in 2021 to 29,527 for home health agencies associated with this physician."
"Furthermore, a review of other home health and hospice programs registered at the same addresses as those tied to this physician shows over 550 home health agencies and more than 250 hospices active in Medicare, including the notorious address in Van Nuys, long flagged by law enforcement for Medicare and Medicaid fraud."
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Fox News obtained the source documents used to support Tenney's letter and shared the records with Faustina, a bright and energetic physician who graduated from medical school in 1963. His primary residence is in Las Vegas, but he agreed to talk with us at an apartment in the Van Nuys neighborhood of Los Angeles.
"[Congresswoman] Tenney claims your national provider number has been used to bill Medicare for $600 million and somehow you're responsible for 29,000," I asked. "How can that be?"
"I don't know them (providers using his Medicare number)," Faustina said. "I don't do the billing. I've never billed Medicare for any of these patients. I'm given $3,000 a month from this home healthcare agency."
"I'm not seeing anybody now. Last month I saw about ten or fifteen charts when I would visit, but that's one day a week."
Yet, federal records show 76,000 claims were filed on behalf of thousands of patients. Records also link him to 18 hospice providers, which he denies.
"I am not associated with any hospice," he said.
We visited several hospices using Faustina's Medicare number. Many looked more like mail drops than medical offices. Several were in run down or largely empty buildings. No one answered the door and phone numbers went to voicemail. Some names had been ripped off the lobby marquee, but were still billing Medicare from that address.
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One address in Van Nuys contained more than 100 hospice or home healthcare agencies, yet I walked through all three floors and didn't see a single patient, family member, doctor, nurse or administrator. The exterior of the building had no signage indicating a provider was inside, and you had to get buzzed in by the building manager to enter.
At another location, an agency that hired Dr. Faustina on a part-time basis said it cut ties after learning Medicare had suspended his billing privileges.
So do you think somebody's probably committing fraud on your behalf?" I asked Faustina.
"Absolutely," he said. "Not on my behalf, on their behalf."