Medicare Compliance & Reimbursement

ENFORCEMENT WATCH:

Medicaid Patients Must Verify Home Health Claims

State AG pursues civil fraud lawsuit against a home health facility.

Filing false home health claims to Medicaid can lead to an audit - which could result in Medicaid fraud charges, as evidenced by the recent case of a Michigan home health provider.

Detroit-based Friends Who Care, Inc., which provides physician-ordered home health and hourly nursing care to severely handicapped patients, faces Medicaid fraud charges and a civil lawsuit, Michigan Attorney General Mike Cox announced on July 18.

What'd they do? FWC allegedly submitted $895,000 worth of fraudulent claims to Medicaid, including $750,000 in services and $145,000 in mileage charges that the company couldn't substantiate in its patient files, Cox says. A Medical Services Administration audit uncovered the alleged billing scheme that led to the Medicaid False Claims charge, which is a four-year felony and carries a maximum $50,000 fine.

Cox also filed a civil lawsuit against the company on July 14 and plans to seek restitution for the false Medicaid billings and more than $3.5 million in treble damages.

To read the press release, go to
http://www.michigan.gov/ag/0,1607,7-164-34739-122647-,00.html.

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