Home Health & Hospice Week

CMS suspends Medicare payments in many cases.

A nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals for their alleged participation in health care fraud schemes involving about $900 million in false billings, included defendants from the home care industry in multiple states.

In Florida: Nine defendants have been charged with operating six Miami-area home health companies for the purpose of submitting false claims to Medicare, including for services that were not medically necessary and that were based on bribes and kickbacks. Medicare paid the six companies more than $24 million as a result of the scheme, the Department of Justice says in a release.

In South Texas: A physician with the highest number of referrals for home health services in the Southern District of Texas has been charged with participating in separate schemes to bill Medicare for medically unnecessary home health services that were often not provided. Numerous companies that submitted claims to Medicare using the fraudulent home health referrals from the physician were paid more than $38 million by Medicare.

In North Texas: A physician certified patients for home health care that was often medically unnecessary, and home health agencies submitted about $23.3 million in billings to Medicare based on the physician’s fraudulent certifications.

In the Chicago area: Six individuals including a physician were charged in three different schemes involving bribery and false claims for home health services and disability benefits, resulting in $12 million in bogus payments.

In Louisiana: Three defendants were charged in a scheme centered on the payment of kickbacks through patient recruiters in exchange for patients who often never received nor qualified for home health care as billed. Once admitted, patient medical records were routinely fabricated and altered to support false claims to Medicare.

In Ohio: Two defendants were charged for their roles in a $7.5 million home healthcare fraud scheme.

The DOJ didn’t single out any hospice cases in its release. But Assistant Attorney General Leslie Caldwell noted in the release that “the Strike Force’s strategic approach keeps us a step ahead of emerging fraud trends, including … fraud involving compounded medications and hospice care.”