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Home Healthcare Fraud

Home healthcare can help protect vulnerable populations and allows them to receive medical attention in their own homes. Receiving home healthcare can make a world of difference in peoples’ comfort and lives. It can also ease the burden on family members and other caregivers.

Unfortunately, home healthcare is also particularly susceptible to fraud and scams. Because home healthcare often takes place with minimal oversight, few to no other staff members, and more interpersonal elements than most in-office visits, the field is ripe for unscrupulous providers seeking to take advantage of the most in-need.

If you have knowledge of or information about home healthcare schemes, you may be eligible to become a home healthcare whistleblower. Whistleblowers who speak up about home healthcare efforts to defraud Medicare, the VA, or other government-backed insurance programs may be eligible to receive significant financial rewards. Doing so also can help protect vulnerable patients and hold providers accountable.

Speaking to a home healthcare fraud lawyer is the best way to find out if you have a viable case. The expert team at Tycko & Zavareei LLP is available to answer any questions you may have. Our experienced attorneys can help ensure that any home healthcare fraud case is pursued to its fullest extent.

Home Healthcare Fraud and Medicare

Home healthcare can be provided by registered nurses, physical therapists, or other home health aides. According to the National Health Expenditures for Medicare, anywhere from $18 to $40 billion is earmarked from the Medicare budget yearly for home healthcare. However, all sources agree that national spending on home healthcare has only continued to grow in recent years. Since 2015, the field has seen a five percent increase per year, and in 2019 home healthcare expenditures leapt upwards by 7.7 percent.

Hospice care and managing chronic conditions are two fields of home healthcare that have grown in recent years. However, due to the rise of COVID-19 many families have also chosen to care for more senior members at home whenever possible, as opposed to opting for enrollment at nursing home facilities.

Common Examples of Home Healthcare Fraud

Home healthcare fraud and scams can be difficult to spot from the outside but represent common forms of Medicare/Medicaid fraud. Often, family members, nurses, billing professionals, and patients themselves are the first line of defense against home healthcare fraud.

Common examples of home healthcare fraud may include, but are not limited to:

  • Kickbacks: Medical professionals who refer patients to facilities with which they share a financial relationship may be engaged in kickback schemes. In a kickback scheme, companies will pay doctors or nurses for their referrals. These financial arrangements are then passed onto patients, even when it may not be in their best interests. Usually, these recommendations are based only on the pre-existing financial arrangement and may even deprive patients of opportunities to seek meaningful care.
  • Upcoding: When medical staff bill Medicare and Medicaid for more complex procedures than were actually performed or needed, this may be an example of upcoding to increase insurance payouts.
  • Billing multiple insurers for the same procedure: Unscrupulous providers may “double-dip” into their providers’ insurance programs without offering increased or better care.
  • Overreporting and overbilling: One particular concern with home healthcare is the overreporting of hours spent or care offered. Because of the personal nature of in-home care, it can be difficult to spot providers who may ignore their patients’ needs while continuing to claim insurance payouts.

Becoming a Whistleblower: Reasons to Speak up about Home Healthcare Fraud

Those who receive home healthcare are often particularly vulnerable. Unethical providers may be neglecting or even abusing the people who depend upon them while also lining their own pockets.

Becoming a whistleblower is one of the best ways to ensure that the care offered to patients is actually what providers say it is. At the very least, home healthcare fraud inflates the cost of healthcare for the taxpayer and reduces the availability of affordable, quality care for those who need it most. In its worst iterations, home healthcare fraud may be perpetrating violent or neglectful abuse.

Furthermore, whistleblowers may be able to receive a significant financial award for their information. In the event of a successful lawsuit to recover misappropriated government funds, like in a home healthcare fraud case, whistleblowers can receive up to 30 percent of the government’s total award.

Home Healthcare Fraud Qui Tam Law

Home healthcare is often funded at least in part by Medicare and Medicaid, as well as by the VA and other federal and state government insurance programs. Because of this, claims made for repayment are subject to the False Claims Act, a powerful law designed to combat fraud and waste of taxpayer funds.

Federal False Claims Act

First passed in 1863, the False Claims Act or “Lincoln Law” is one of the nation’s strongest tools when it comes to combating healthcare fraud. The False Claims Act currently states that any individual knowingly making false claims to the government may be liable for treble damages, plus an individual financial penalty per false claim. The amount of this financial penalty is linked to inflation rates.

In addition to these punitive civil actions, whistleblowers who have substantively contributed to successful cases by sharing previously unreleased and unreported information may be eligible to share in the overall government recoupment. Whistleblowers, or “qui tam relators,” can receive up to 30 percent of the government’s total financial award. In cases of extensive or ongoing fraud, this amount can number in the tens of thousands or even millions of dollars.

Recent DOJ Home Healthcare Fraud Cases and Settlements

The Department of Justice has made a concerted effort to crack down on home healthcare fraud cases and unethical providers. However, individual caregivers are not always to blame in instances of home healthcare fraud. In one recent case, two home healthcare agencies, All American Homecare Agency (All American) and Crown of Life Care NY LLC (Crown of Life) were ordered to pay a settlement of $5.4 million in addition to missing wages and benefits to chronically underpaid home healthcare aides. Both agencies claimed that they had paid minimum wage amounts to home healthcare aides in their employ while drawing on Medicaid funds.

In another case involving kickbacks and payments for referrals, three home healthcare companies, namely ANG Health Care Inc., Excel Home Healthcare Inc., and Excel Hospice Inc. allegedly submitted over 8,000 claims to Medicare, which paid them approximately $31 million for the fraudulent claims.

What to Do if You Suspect Home Healthcare Fraud

If you have information about home healthcare fraud, the best thing to do is to contact a qui tam lawyer who can advise you on how to proceed. Every case is different, and attention to detail in qui tam law is crucial.

Keeping a record of suspected instances of fraud can be helpful. However, speaking to a home healthcare fraud attorney will help you understand what kinds of patient and employer confidentiality need to be respected when collecting and sharing your proof.

Finally, speaking to a home healthcare fraud lawyer will help avoid any situation wherein you may become implicated in cases of ongoing fraud. When in doubt, especially when vulnerable patients are involved, it is always better to speak up.

Contact Our Home Healthcare Fraud Attorneys

The expert law team at Tycko & Zavareei LLP has a proven track record of success defending the rights of whistleblowers, especially in healthcare fraud cases. Our attorneys could take the lead in filing a lawsuit with your protected disclosure and help pursue justice in instances of home healthcare fraud.

Reach us by phone or online via our confidential and complimentary case evaluation form.

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