In 2015, reports show that Medicare provided reimbursements for over 11,000 home health agencies a total of over $18.4 billion for their services. Estimates show that roughly half of these total costs were improper.
Home health is extremely vulnerable to waste, abuse, and fraud. In fact, since 2013, the Centers for Medicare & Medicaid Services imposed a number of new home health agencies in various areas to determine if they are at high risk for fraud.
Types of Home Health Care Fraud We See
CMS relies on beneficiaries to help determine if fraud and abuse in-home health care is taking place. This program specifically calls on beneficiaries to look out for various activities and report them as soon as possible. Some types of home health care fraud include:
- When agencies up code the types of services they provide to obtain higher payments.
- When agencies submit bills for patients who are not actually homebound.
- When home health staff visit homes without medical necessity.
- When agencies bill for ordered services that were not provided to patients.
- When providers are billed for services and equipment that is not received by the patient.
- When home health care agents fake signatures on medical forms or orders for equipment.
- The provision of home health care services without a doctor order.
- Pressuring patients to accept items and services they do not need.
- When home health care agents offer goods or services in exchange for Medicare numbers and information.
Penalties for Home Health Care Fraud
When people are convicted of home health care fraud, they face an array of consequences. This serious offense can result in a five-year prison sentence per offense in relation to making false statements or claims to Medicaid or Medicare. Additionally, those convicted of federal health care fraud can result in an additional ten-year sentence for each offense.
In addition to prison sentences, offenders can expect to pay substantial fines for their actions and lose coverage for health care. Working with a home health care fraud defense attorney in your area will ensure you have the best chances of beating your case.
Our Team Can Help You
There are numerous instances where patients, vendors, surgeons, and other medical professionals and providers are accused of engaging in fraudulent actions. Not implementing a sound record-keeping system can drastically hinder the accused from proving their innocence. When providers and patients are accused of home health care fraud and engaging in other types of healthcare fraud, it is crucial that they contact an aggressive defense attorney as soon as possible.
Healthcare Fraud Group has decades of experience fighting to protect the rights of those accused of white-collar crimes throughout the entire country. Our team provides aggressive and competent legal representation to help those accused prove their innocence. Contact our law firm today at (888) 402-4054 to protect your legal rights.
