Excel Hospice: Sacramento Referral Payments Through Hospital and Facility Staff

The Excel Hospice Sacramento kickbacks case involved approximately $31 million in Medicare payments to ANG Health Care, Excel Home Healthcare and Excel Hospice, with the government alleging that the owners bought patient referrals from hospital and facility staff. A registered nurse, social-services directors and a director’s spouse appear in the Justice Department’s account. For an insider, the connection is concrete: who received the money, which patients came through that relationship, and which agency billed Medicare.

Three Agencies in the Same Referral Case

Excel Hospice operated alongside home-health businesses under shared ownership and control in the greater Sacramento area of California. The government identified the companies as ANG Health Care Inc., Excel Home Healthcare Inc. and Excel Hospice Inc. Its account described more than 8,000 Medicare claims for home health care and hospice services across the agencies.

Within the combined payments, the Justice Department identified more than $2 million for services purportedly provided to beneficiaries referred in exchange for kickbacks to the recipients it named. That was Medicare reimbursement tied to bought referrals.

This hospice fraud case follows patients into both home health and hospice. For someone who knows the referral arrangements, the provider name on the resulting healthcare claim matters.

What the Owners Told Medicare

The owners certified to Medicare on behalf of the agencies that they would not pay kickbacks for beneficiary referrals. The Justice Department said they nevertheless paid and directed others to pay for referrals from at least July 2015 through April 2019.

The alleged contradiction sits inside the business: a promise against kickbacks, payments even to a referral source’s husband. Medicare and hospices competing without buying patients were on the losing side of that arrangement. An employee who knows who authorized a payment may understand something that the referral form never says: why that person was being paid.

That is the point of hospice referral kickbacks as a false-claims mechanism. The agency acquires the patient through a paid relationship and then seeks payment from Medicare. The government’s account said the agencies should not have received Medicare reimbursement for referrals obtained through kickbacks.

Who Received the Referral Payments

The government’s account reaches hospital nursing, facility social services and a family relationship. It identifies a registered nurse at a Sacramento hospital, a social-services director at a Sacramento skilled-nursing and assisted-living facility, that director’s husband, and a social-services director at a Roseville skilled-nursing facility.

The government alleged payments to people in those positions for beneficiary referrals. For someone inside a hospital or facility, that matters: the referral relationship can involve a member of staff personally. We examine who received the money as well as where that person worked.

The spouse is the telling detail. A review limited to the names of hospital and facility employees would miss a payment made to a spouse. We examine the relationship behind the recipient’s name alongside the patients sent to the provider.

Why a Facility Referral Stream Is Valuable

A facility referral can bring a hospice a patient whose enrolled days generate Medicare revenue. The Medicare Payment Advisory Commission’s March 2026 report describes payment by the enrolled day, with more services at the beginning and end of a stay and fewer in the middle. Medicare keeps paying for the enrolled days between those endpoints.

The HHS Office of Inspector General examined the assisted-living business in its January 2015 report, Medicare Hospices Have Financial Incentives to Provide Care in Assisted Living Facilities. Its analysis of Medicare hospice claims from 2007 through 2012 found longer stays and higher payments for beneficiaries in assisted living than in other settings. Its summary put the relationship between visits and payment plainly:

That finding explains the value of access to residents. A referral can bring an extended stream of daily payments. In the Excel case, the alleged purchase happened at the point where hospital and facility contacts could send patients to the agencies.

Is Hospice Recruitment at Assisted Living Facilities Fraudulent?

Buying referrals to assisted-living residents can make the Medicare claims that follow false, even when the patients receive appropriate hospice care. The payment for the referral is the problem this case brings into view.

Hospice eligibility fraud concerns the clinical basis for enrollment and continued care. A bought-referral case follows the financial relationship that brought the patient to the agency. For someone in intake or billing, the relevant information may sit in a payment approval or a conversation about referrals, outside the clinical chart. Understanding that arrangement connects the agency’s spending to its Medicare claims.

The Records That Connect Payment, Referral and Claim

An insider’s account is strongest when the payment, the referral relationship and the subsequent billing can be connected. We examine who authorized the payment, what the recipient was expected to supply, which patients followed, and which agency submitted their claims.

We work with you to connect payment approvals, referral messages, admission records and Medicare billing records to show who arranged the payments and which agency billed for the patients. In a business with both home-health and hospice agencies, that last connection keeps the account tied to the provider that actually billed.

The spouse in the government’s account also shows why a name on a payment is only a starting point. We want to understand the recipient’s relationship to the referral source and the decisions behind the payment. A hospital or facility employee may know the referral side, while an agency employee may know the approval or billing side.

Can You Give Gift Cards for Referrals?

Gift cards given for referrals are among the kickbacks the government has alleged in hospice cases. In the April 2017 Hospice Plus settlement, Hospice Plus and Curo Health Services were among the companies that agreed to pay $12.21 million over alleged referral payments.

The government described cash, gift cards and other valuable items going to doctors, nurses, hospitals and long-term-care facilities. A separate arrangement allegedly supplied a physician housecall company with sham loans, an equity interest, dividends and free rental space. For an insider, the comparison broadens the question from who received a check to who received something valuable in return for patients.

The connection between the benefit, the referral and the claim is also what makes an insider’s knowledge useful to a hospice whistleblower case. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers, as a 2020 paper in the Journal of Forensic and Investigative Accounting explains.

You Know Why the Patient Was Referred

If you saw agency payments follow hospital or facility referrals, tell our whistleblower experts what connected the money to the patients. We work beside you to build the case from that inside knowledge and bring in hospice fraud whistleblower lawyers who understand referral arrangements and Medicare billing. From the first call, we stay beside you to build your strongest hospice kickback whistleblower case.