Home Healthcare Fraud
Serving Clients Nationwide
Medicare’s home health benefit provides payment to a Home Health Agency (HHA) for care given over a 60-day period. To qualify for the home health benefit, patients must be certified as “homebound,” meaning that they must be unable to leave their home except for occasional short trips for medical care. In addition, home healthcare must be well documented, administered according to a physician-established plan of care, and be medically necessary for the patient’s unique condition. The care provided must also fall under one of the approved categories:
- Physical therapy
- Speech-language pathology
- Intermittent skilled nursing
The amount of payment made to the HHA is determined by Medicare according to the Outcome Assessment Information Set (OASIS) form, which lists the number of visits and level of need for the patient. Payment amounts also depend on the Home Health Resource Group (HHRG) to which the patient is assigned under Medicare. Because payment is determined based on information submitted by the party receiving the payment (the HHA), there is a significant opportunity for HHAs to commit Medicare fraud to increase the amount of payments they receive.
Types of Home Healthcare Fraud
Home healthcare fraud is typically perpetrated by submitting claims in a way that is not compliant with the Medicare home health benefit requirements or by falsifying information reported to Medicare in order to receive more money for a patient. For example, the HHA may fail to properly certify and document the medical needs and homebound status of the patient with a physician. HHAs may also bill Medicare for services other than those approved under the home health benefit.
Another common practice is upcoding, reporting the patient’s condition as more severe to qualify for greater compensation. In addition, financial arrangements between HHAs and referring or certifying physicians may be in violation of the Stark Statute and/or the Anti-Kickback Statute.
Becoming a Whistleblower on Home Healthcare Fraud
If you have knowledge that an HHA is in any way falsifying or manipulating information submitted to Medicare to qualify for greater compensation or if you have knowledge that an HHA is in any way noncompliant with the requirements of Medicare’s home health benefit, you may be able to bring a qui tam lawsuit against the HHA. With the help of the qui tam attorneys at Kenney & McCafferty, you can become a whistleblower to hold the home healthcare provider accountable for fraudulent billing practices.
The False Claims Act allows individuals with knowledge of fraud to receive 15-30% of the amount recovered as a whistleblower reward, and the total amount recovered may be up to triple the amount of the fraudulent claims submitted. Kenney & McCafferty’s qui tam lawyers have the experience necessary to maximize your whistleblower compensation while defending you from retaliation by the HHA.
If you have knowledge of a fraud or false claim against the government, please contact our qui tam lawyers today. Kenney & McCafferty attorneys will consult with you about your case, without obligation. All communications with Kenney & McCafferty attorneys during these consultation services are confidential and protected by the attorney-client privilege.