Home Healthcare Fraud Attorney in Denver

Home healthcare agencies exist to help the elderly, the disabled, and those with health conditions who cannot leave their homes to seek treatment. While many of these agencies provide critical services, some take advantage of the circumstances by fraudulently collecting money from government agencies. But home healthcare fraud is far from a victimless crime. It can cost insurers and taxpayers dearly and lessen the quality of care received by deserving patients.

If you know or suspect that a home healthcare agency is depriving Medicare or Medicaid of funds that rightly belong to patients in need, you may be considering a whistleblower lawsuit. The Colorado home healthcare fraud lawyers at The Wilhite Law Firm can help you file a claim and support you through the legal process. Call or contact us today for a free consultation.

What is Home Healthcare Fraud?

Medicare Part A and Medicare Part B both cover home healthcare services required on a short-term or as-needed basis. Home healthcare agencies must obtain approval from Medicare and work with licensed physicians who manage a patient’s care to receive funding from Medicare.

Patients typically only qualify for Medicare coverage of home healthcare when:

  • A physician determines that skilled home healthcare services are medically necessary. Examples of skilled home care services include part-time nurse visits, nurse aide visits, and rehabilitation services such as speech-language pathology or physical therapy.
  • The patient’s condition is expected to improve within a reasonable timeframe, or the patient needs skilled care to prevent their condition from worsening.
  • The patient is homebound, meaning they cannot leave home without assistance or it is simply too risky given the patient’s condition. Patients may only leave their homes for medically necessary appointments or other infrequent outings such as religious services.

Home healthcare fraud occurs when the agencies that provide at-home care charge the federal government for unnecessary or non-existent services. If an agency gives at-home care to a patient who is not homebound or seeks reimbursement from Medicare for unrendered services, the agency can be held responsible for home healthcare fraud.

How Do I Identify Home Healthcare Fraud?

Medical BillHome healthcare fraud can take several different forms. Some common red flags that may indicate the presence of home healthcare fraud include:

  • At-home care is provided to patients who have not recently visited a doctor to certify that the home health services are medically necessary.
  • Home health care is provided to patients who have not recently stayed in a hospital or nursing home.
  • The patient’s primary condition is either diabetes or hypertension.
  • The patient has received multiple at-home care services in a short timeframe.

Government watchdogs also suggest looking out for the following activities that could indicate a home healthcare agency is guilty of fraud:

  • Billing for upcoded services to obtain more money
  • Billing for services for patients who are not actually homebound
  • Submitting separate claims for bundled services and the same duplicate services unbundled
  • Billing for at-home visits that are not medically necessary
  • Billing for services or equipment that were never delivered
  • Forging signatures on medical documents or equipment orders
  • Urging patients to accept services or equipment they do not need
  • Providing at-home services that a doctor did not order
  • Offering free goods or services in exchange for Medicare numbers

What Are Some Home Health Fraud Case Examples

The following examples of fraudulent healthcare billing serve as illuminating case studies of home healthcare fraud:

In one recent case, 10 individuals were arrested in New York as part of an in-home health aid fraud scheme. According to the U.S. Attorney in Manhattan, the defendants are suspected of stealing from the healthcare system since 2015 by billing for no-show appointments in which patients never actually received care. If convicted, each of the 10 defendants faces up to 85 years in prison for various charges.

In another case, one Texas physician and five home healthcare agency owners were charged with fraudulently billing Medicare and Medicaid for almost $375 million. According to reports, the fraud involved falsely certifying roughly 11,000 patients as homebound through a network of more than 500 agencies. The accused allegedly billed Medicare for multiple services that were either medically unnecessary or never actually rendered.

What Are Some Types of Home Healthcare Fraud

Some common types of home healthcare fraud include:

  • Plan-of-care fraud: Home healthcare agencies must provide their services based on a plan of care established by a licensed physician. To develop a plan of care, the physician must determine that the patient is homebound and then certify a specific plan, which must be recertified if care is needed for more than 60 days. Plan-of-care fraud occurs when home healthcare agencies provide services to patients who aren’t actually homebound or don’t have a valid plan of care from a physician.
  • Kickback fraud: This type of fraud occurs when a home healthcare agency gives a physician money or other benefits to certify a patient as homebound falsely. Kickback fraud can also happen when home healthcare agencies with ownership stakes in assisted living facilities (ALFs) refer their patients to those facilities and then provide at-home care in the ALF.
  • Hospice fraud: Under Medicare, patients are eligible for this type of care if their physician determines they have fewer than six months to live. It is common for providers to admit patients who are not terminally ill or have a life expectancy that exceeds six months.
  • Fraudulent billing: Home healthcare agencies engage in fraudulent billing when they charge Medicare for unnecessary or unrendered services.
  • Forgery: Home healthcare providers who fake a physician’s signature or use false information to certify a patient as homebound commit forgery. Forgery may occur separately or as part of any other type of healthcare fraud.

How Do I Report Suspected Fraud?

If you know or suspect that fraud is occurring, it’s necessary to file a qui tam lawsuit under the False Claims Act with the help of a knowledgeable attorney. Under the protection of the federal Whistleblower Protection Act, employees who suspect fraud are shielded from retaliation.

If you can successfully prove the existence of fraud, you may be entitled to compensation, also known as a whistleblower reward. The amount you can receive for a whistleblower reward is based on the amount of money the federal government gets back from the perpetrator. You could receive between 15 or 25 percent of the total amount recovered, depending on the circumstances.

Contact a Home Healthcare Fraud Attorney in Colorado Today

At The Wilhite Law Firm, our attorneys have zero tolerance for fraud and abuse in our healthcare system. We can help you file a qui tam lawsuit to hold fraudulent parties accountable and recover fair compensation for your efforts. Contact us today to discuss your case in a free consultation.