Home Healthcare Fraud

What is home healthcare fraud?

Home healthcare fraud under the False Claims Act includes billing federal and state health insurance programs for medically unnecessary services or services that were not provided, and paying kickbacks for patient referrals.

Home health care is an area in which many providers have engaged in fraudulent schemes that violate the False Claims Act.

To be reimbursed by government-funded insurance programs (Medicare, Medicaid, or TRICARE) for home health care services, providers must be able to document, among other things, that (a) they have actually rendered the services for which they are claiming reimbursement, and (b) the services were medically necessary. In addition, providers cannot claim payment from federal health care programs for home health care services resulting from an inappropriate referral from a health care provider, i.e., conduct that would violate the Anti-Kickback Statute or Stark Act.

As an example of home health care fraud, in September 2011, Maxim Health Services, Inc., a provider of in-home health and nursing services, agreed to pay $150 million in civil damages and criminal fines to settle fraud allegations first raised in a qui tam whistleblower lawsuit. The lawsuit alleged that Maxim fraudulently billed federal and state health insurance programs for services that weren’t provided.

Five months later, in February 2012, the Department of Justice announced the arrest of a physician who was certifying that thousands of patients per year needed home health care services. The government has alleged that this physician and his cohorts, including people who worked at home health care agencies, were recruiting thousands of patients who had no need for home health care, and then billing Medicare for services that were not provided to these patients. The government alleges that the defendants caused the submission of approximately $375 million of false claims in the course of this scheme.

VSG’s Qui Tam Attorneys Are Experienced in Handling Home Healthcare Fraud Cases

VSG successfully represented a whistleblower in a qui tam False Claims Act case alleging that U.S. Homecare Corporation was billing Medicare for home health care visits purportedly made by subcontractors, where the subcontractors were creating fraudulent entries in patient charts to substantiate the claims.