Getting to the Bottom of Home Health Care Fraud

The time has finally come; if you are attempting to defraud Medicare, watch out. The Centers for Medicaid & Medicare Services (CMS) is now seeking the assistance of an outside company to develop a plan to get to the bottom of fraud in the home health care system.

While the Medicare and Medicaid systems are multi-billion dollar programs that engage with and pay countless home health companies that are completely legitimate and have appropriate billing practices, the number of companies that try to overbill and otherwise defraud the system has reached epidemic proportion.

CMS has had enough and is putting in place a pilot program to attempt to uncover the true depth of the problem and to instill guidelines to prevent the situation from escalating further.

More than $16.5 billion was paid out to home health companies by Medicare in 2013. In the four years since 2010, almost $1 billion of those claims are believed to be fraudulent. The US Health and Human Services Office of the Inspector General has confirmed that the number of home health companies that are overbilling, billing for services not performed, etc. is a true threat to the efficacy of the entire program.

When CMS hires the independent company to oversee the pilot program, investigations will begin in Florida. According to reports, $2.1 billion in Medicare home health claims were filed in that state. The program will begin with a review of 130 specific home health care firms located in Miami-Dade County in South Florida. If the pilot program works on the small scale as described, CMS expects to investigate a larger number of home healthcare companies across the country.

Moving forward, the chief executive officer of the National Health Care Anti-Fraud Association Louis Saccoccio said the home healthcare program is just one of many areas his team wants to investigate. “Although this project will initially focus only on home healthcare, I think it is a solid first step to begin to determine some statistically valid estimate of the percentage of fraud in the program.”

If you or someone you know has information about a scheme to defraud the government, you owe it to yourself to learn what’s involved with being a “whistleblower.” If your information leads to the government recouping funds, you will be entitled to a percentage of those damages.

Contact experienced qui tam lawyer Ross Begelman at Begelman & Orlow, P. C. today for a free consultation about your case.

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