Understanding Home Health Care Fraud

At the most literal level, home health care means exactly what it says: It is health care that is provided at home. It is typically used for aging and elderly people who want to remain independent and live on their own, but still need medical care because they are homebound. Being homebound means that due to an illness or injury, you have trouble leaving your home without help, or are not recommended to leave your home. Medicare pays benefits to those who are homebound if there is a skilled need.

There are five requirements to qualify for home health care benefits from Medicare, they are:

• You are under the care and regular review of a doctor;
• You have a doctor-certified need for one or more of these services: physical therapy, occupational therapy, speech therapy, or skilled nursing;
• The agency administering your care is Medicare approved;
• You are homebound, and a doctor certifies that you are;
• You do not need more than part-time or “intermittent” skilled nursing care.

Home health care is an extremely fast-growing industry. According to the Bureau of Labor Statistics, over 1 million new jobs within home health care will be added by the end of 2020. This represents an almost 70% growth in home health care positions by the end of this year. That number dwarfs the overall expected 14% growth rate among all other jobs on average.

COMMON HOME HEALTH CARE FRAUD SCHEMES

Increases in fraudulent activity typically follow any booms in business as evidenced by home health care. Home health care fraud has become more common and more lucrative for those willing to take the risk. Common home health care fraud schemes include:

• Plan of care fraud: Home health services must be provided under a plan of care from your doctor. A doctor must certify that a patient is homebound and is under a legitimate plan of care in order to receive Medicare benefits. Home health care providers committing fraud will treat patients who are not homebound or under a plan of care and still bill Medicare for the services.
• Fraudulent billing: This includes billings for medical services that were not rendered. Common ways to do this include home health care providers billing for visits that were never made, or billing for medical services that they don’t even perform.
• Illegal doctor kickbacks: It is illegal for doctors to receive kickbacks for referring patients. These kickbacks are often concealed and are given in the form of paid trips or speaking fees.
• Assisted living facility fraud: This type of fraud occurs when a home health care company has an ownership interest in an assisted living facility and provides home health care services at the facility and bills Medicare. It is also illegal in this scenario to self-refer Medicare patients to the assisted living facility.

This is not a comprehensive list by any means. There are limitless types of home health care fraud schemes that currently exist, and they will continue to evolve as the industry grows.

HOW DOES THIS AFFECT ME?

If you are a doctor or home health care provider, you might be at risk. The scrutiny of Medicare billings is increasing as the industry increases exponentially. If you are an employee of a home health care provider and are a witness to home health care fraud within your place of employment, then you might be eligible for a reward as a whistleblower in a qui tam lawsuit. If you have any questions about the current practices within your home health care business and if those practices are in legal compliance, then it is important to speak to an experienced federal health care fraud attorney immediately. It is your responsibility to understand the law as it applies to you. Ignorance of the laws governing home health care is not an excuse or legal justification to any alleged wrongdoing.