A new government study reports that Medicare is paying for home health care services under circumstances suggesting fraud, waste, and abuse.  This is no small matter.  Medicare pays nearly $20 billion per year to home health care agencies for services provided to 3.4 million beneficiaries.

The latest study by the Office of the Inspector General (OIG) of the Department of Health and Human Services compared Medicare claims for home health care services with claims for inpatient hospital and skilled nursing facility services for the same patients.  The results were shocking.  The OIG study found numerous instances where:

  • claims were made to Medicare for home health care services and for inpatient hospital stays for the same patients at the same time
  • claims were made to Medicare for home health care services and for skilled nursing facility stays for the same patients at the same time; and
  • claims were made to Medicare for home health care services allegedly provided after the patient’s date of death.

If that isn’t enough to make your blood boil, here’s the real shocker.  Looking at larger trends, the OIG study found that 25% of home health care agencies – that is one out of every four – exhibited a pattern of unusually high billing under at least one category that OIG uses to identify questionable billing practices.

Billing patterns, of course, are only a starting point.  Billing patterns may be an indication of Medicare fraud, or they may be the result of a legitimate home health care agency with a high number of patients needing a particular type of treatment.  Often, the only way to tell the difference is by talking with the people who actually work for the home health care agency.

That is why the government pays very large rewards to health care workers and others who help uncover Medicare fraud. 

Under the False Claims Act, a whistleblower can be paid between 15% and 30% of the amount the government recovers in a lawsuit against a company engaged in Medicare fraud.  And because the government is able to recover three times the amount that was paid going back six to ten years, that reward can add up to hundreds of thousands, and sometimes millions of dollars.

If you are aware of false claims being made to Medicare or Medicaid, then you should consult with an experienced lawyer immediately.  To schedule a free and confidential consultation by telephone or in person, call my office today at (212) 601-2728 or click here to communicate with me via email.

John Howley
New York, New York

The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation.  I invite you to contact our law offices and welcome your calls, letters and electronic mail.  Contacting us does not create an attorney-client relationship.  Please do not send any confidential information to us until such time as an attorney-client relationship has been established.  I practice law and offer legal services only in jurisdictions where I am properly authorized to do so.  I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules.

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