Home Health & Hospice Week

HHA denies wrongdoing in alleged fraud uncovered by grandma.

You'd better make sure you're following the rules, because you never know who will be watching.

That's what Morning Star Home Care Inc. in Pharr, Texas has learned the hard way, thanks to a sting operation run by ABC News. In the story introduced by Diane Sawyer, an undercover 82-year-old grandmother is taken by a patient recruiter to Dr. Padmini Bhadriraju, who certified the healthy, active senior for home care based on made-up diagnoses such as diabetes.

Bhadriraju's attorney told ABC News that someone else must have filled in the incorrect information on the grandma's form. A later statement from Bhadriraju's attorneys blamed any diagnostic errors on the home care agency, reports The (McAllen) Monitor newspaper.

But Morning Star denies any wrongdoing. "There was no fraud," agency administrator Estela Sotelo told the newspaper. While Bhadriraju's initial referral mentioned diabetes, Morning Star didn't include that in its final orders after an assessment, Sotelo said. She defended the agency's assessment of the grandma as homebound, saying activity level didn't necessarily indicate the need for treatment.

"I understand the whole purpose of this undercover -- I am for it," Sotelo told The Monitor. "(But) I didn't do it. I do not go to sleep at night and plan to defraud the government...We are not what the nation thinks we are."

However: The news report seems to show clearly that the patient is not homebound, argues Rachanna Rodriguez, national coordinator for the National Hispanic Senior Medicare Patrol.

The feds are now investigating the case, ABC News reports.

Legitimate HHAs will end up paying the price for this reported fraud as well, experts fear. The attention-grabbing national story is "another black mark" on the industry, laments Tom Boyd with Boyd & Nicholas in Rohnert Park, Calif.

Note: Watch the ABC News segment at http://abcnews.go.com/Blotter/undercover-82-year-grandma-catches-medicare-fraud-tape/story?id=15818462.