As investigations into California's hospice fraud crisis accelerate, the founder of a Los Angeles hospice agency is urging authorities to let the industry help craft solutions, while simultaneously casting doubt on the scale of the problem investigators have uncovered.
Kevin Tutunjian, who has run In the Arms of Grace Hospice since 2011 and sits on the board of the California Hospice and Palliative Care Association, told The New York Post that fraud claims are "nuanced" and that he doubts the dollar figures reach "anywhere in the billions."
His preferred remedy: bring providers and stakeholders to the table so they can be "a part of the solution."
That's a remarkable posture for an industry sitting atop numbers that speak for themselves.
A 2022 state audit report found that California has 2,836 licensed hospice agencies. More than 1,800 of them are concentrated in Los Angeles alone.
For context:
Read those figures again. Los Angeles, a single county, housed more than 1,800 hospice operations, while the entire state of New York managed with 43. That is not a thriving marketplace. That is a billing apparatus.
Tutunjian's response to numbers like these was to shift blame to the state itself:
"Why did we issue so many licenses and then turn around and say, look how many hospices there are — they're all committing fraud."
It's an interesting deflection. The state issued the licenses, sure. But the state didn't force anyone to apply for them. The question isn't why Sacramento approved so many applications. The question is why so many people suddenly wanted into the business of caring for the dying in one specific corner of the country.
Tutunjian drew a distinction between outright fraud and something softer. He described the landscape idistinguishedar move.
Redefine the problem downward. Separate the "blatant" criminals from the merely incompetent, and suddenly the crisis looks smaller, more manageable, more like a staffing issue than a systemic looting of Medicare.
But taxpayers footing the bill don't much care whether their money disappeared because someone was crooked or because someone was "ill-equipped." The result is the same: billions in public funds flowing to agencies that either can't or won't provide the end-of-life care they're billing for.
Families trusting that a loved one is receiving comfort in their final days, while the meter runs on services that may never materialize.
Tutunjian also suggested the situation may have improved on its own, telling The Post he thinks conditions have changed in recent years:
"I think if you came here like five years ago, maybe that would have been appropriate. But I think now it might not be the same."
In 2022, Governor Gavin Newsom signed legislation placing a moratorium on new hospice licenses. That a moratorium was necessary at all tells you everything about the scale of the problem the industry now wants to call "nuanced."
The most revealing part of Tutunjian's pitch is his proposed solution. Rather than calling for aggressive enforcement, clawbacks, or criminal prosecution, he wants the industry embedded in the reform process:
"Providers and stakeholders need to be at the table, we need to be a part of the conversation, and we need to be a part of the solution."
He framed the path forward as a public education campaign, encouraging families to ask the right questions when selecting a hospice. Do they have a volunteer program? A bereavement care program? Accreditation? He described these as markers of quality that consumers should demand.
"It goes back to educating the public and the consumer on the right questions to ask."
There's nothing wrong with consumer education. But when an industry is hemorrhaging taxpayer money through fraud so extensive that it triggered a statewide licensing moratorium and a federal investigation, suggesting that families simply ask better questions is not a serious answer.
It shifts the burden of accountability from the providers billing Medicare to the grieving families navigating an impossible moment.
Dr. Oz is reportedly ramping up an investigation into California's health sector. The specifics remain unclear, but the hospice industry's exposure in the state is enormous, and the audit numbers provide a roadmap for anyone willing to follow the money.
California's hospice explosion didn't happen because Los Angeles suddenly developed an extraordinary commitment to dignified end-of-life care.
It happened because Medicare's fee-for-service structure created a gold rush, and Sacramento's licensing regime waved people through the door for years before anyone bothered to count heads.
Legitimate hospice providers exist, and Tutunjian may well run one of them. But the industry's instinct to minimize, reframe, and invite itself into the enforcement conversation is precisely the posture that allowed 1,800 agencies to bloom in a single county while New York got by with 43.
Families trusted these agencies with the people they loved most. The system owed them better than "nuance."
