Home Health Medicare Fraud: How to Report and Identify Waste and Abuse

Medicare fraud is one of the most common types of fraud in the U.S. today. Home healthcare fraud, a type of Medicare fraud, makes up a significant share of fraudulent activity in America. What makes home health Medicare fraud and abuse difficult to identify and report is the cunning with which doctors and healthcare professionals prey on the sick and elderly.

What makes matters worse is that the beneficiaries who receive home healthcare services are not the only victims. Taxpayers have billions of dollars stolen from them every year in the form of home health Medicare fraud.

Below, we examine the most common types of home health Medicare fraud and give you the tools to identify and report fraud if you witness or suspect it.

What is Home Healthcare Fraud?

Home healthcare fraud is fraud committed by home healthcare companies. It can take many forms but generally involves a healthcare professional intentionally misrepresenting medical claims or records to defraud Medicare out of money. The federal government is hardly the only victim of home healthcare fraud, as it costs American taxpayers billions of dollars every year. It can also lead to poor and unnecessary care of the sick and elderly.

Common Home Healthcare Fraud Schemes

Home healthcare fraud can come in many different forms. Here are some of the most common types of home healthcare fraud:

Red Flags for Medicaid Fraud

When fraud occurs, there are numerous red flags to be on the lookout for. These signs of fraud can take place either at home or at a hospital or doctor’s office. Some of the red flags for Medicaid fraud include:

Examples of Healthcare Fraud:

What is the Difference between Fraud and Abuse?

In the healthcare industry, fraud is any attempt to intentionally misrepresent some aspect of care in order to receive undue funds from the government. This includes many of the examples listed above, as well as others.

On the other hand, abuse in healthcare is any physical, emotional, or verbal harm committed by a healthcare provider against a patient, but it can also refer to improper or unethical business practices such as kickbacks for referrals or prescriptions, as these practices are inherently harmful to vulnerable patients who trust their doctors to prioritize their medical needs.

The difference between fraud and abuse is that with fraud, the healthcare professional makes a statement or claim to the government, whereas with abuse, they do not.

Hospice Fraud and Abuse

Hospice is a form of home healthcare, as services are provided in the home to a patient who is terminally ill and nearing death or whose mobility is limited by a medical condition. Unfortunately, just like home healthcare companies, companies that provide hospice care can also be guilty of fraud and abuse. The most common ways hospice companies commit fraud or abuse include:

What is the Fraud and Abuse Control Program?

The Health Care Fraud and Abuse Control (HCFAC) Program is a government program directed by the Attorney General and the Health and Human Services Inspector General that coordinates efforts at the federal, state, and local levels to combat fraud.

How to Report Home Healthcare Fraud

If you suspect a home health Medicare company is committing fraud, now is the time to step up and report wrongdoing. However, because of the complex nature of home healthcare fraud, you may want to consider contacting a skilled home health Medicare fraud attorney to help you on your journey.

Reporting fraud may classify you as a whistleblower, which comes with certain protections and provisions under the False Claims Act. To fully leverage all aspects of the law, the assistance of an experienced lawyer may be beneficial.

When to Hire a Whistleblower Lawyer

Witnessing or being the victim of home health fraud or abuse is a serious matter. It can also be a situation in which you are unsure of what to do next. Hiring a lawyer might be the best next step if you can answer yes to any of the following questions:

Am I Eligible for a Whistleblower Reward?

The False Claims Act (FCA) was enacted by Congress to combat fraud, abuse, and the waste of government funds. It applies to any business that deals with government money or contracts, including companies in disaster relief, agriculture, defense, and healthcare.

Essentially, the FCA encourages ordinary citizens to be on the lookout for fraud and report it when they see it. The way the law does this is by allowing citizens to file lawsuits (known as qui tam lawsuits) on behalf of the government against individuals and companies suspected of fraud.

The law has two key features that apply to those who bring a qui tam case on behalf of the government:

This means that if you successfully blow the whistle on home health Medicare fraud, you could be eligible for a substantial financial reward.

Report Home Health Medicare Fraud with a Lawyer’s Help

Home health Medicare fraud is a serious problem in the healthcare industry. If you suspect fraud, you can help put a stop to it by working with a dedicated whistleblower attorney. If your case is successful, you may also be eligible for a whistleblower reward. 

© 2024 by Tycko & Zavareei LLP
National Law Review, Volumess XII, Number 266