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The Federal Government Intensifies Home Health Fraud Prosecutions

Categories: Health Care Fraud

Texas Tricare Fraud Attorneys - Oberheiden & McMurrey, LLP

 

Dr. Nick Oberheiden, Esq.
www.federal-lawyer.com
1-800-810-0259
Including Weekends

The Rapid Expansion of Home Health Services

The home health services industry is currently one of the fastest growing industries in America. According to the federal government’s Bureau of Labor Statistics, the need for home health services could increase by as much as 48% by 2022. In order to fulfill this rising demand, healthcare companies generally require minimal to no medical training for home health service providers. Indeed, Medicare provides for compensation to friends or family members of patients who are appointed as their home health service providers. Home health services are becoming more and more attractive to elderly patients who cannot afford, or do not yet require, the full service of a nursing home.

What Are Home Health Services?

Home health services are medical and caretaking services provided to patients who, due to their condition, are not recommended to leave their homes. In order to qualify for home health services, a patient’s primary care physician must certify that the patient is “homebound” and requires one or more specifically enumerated services that can be provided in an out-patient environment, such as physical therapy or intermittent skilled nursing care.

What Is Home Health Fraud?

Home health fraud typically involves either fraudulent billing for services or false certification of the need of services. Common types of home health billing fraud include billing for unnecessary or unprovided procedures, tests, or equipment, paying kickbacks to patients for the use of their Medicare/Medicaid number to charge for services, and inflating bills through exaggerated billing codes. False certification fraud typically involves a physician receiving kickbacks for certifying ineligible patients as eligible for home health services or a physician other than the patient’s primary care physician providing the certification.

Government Investigation and Enforcement on the Rise

With the growth of the home health services industry has come increased government attention on monitoring service providers and prosecuting those providers suspected of defrauding healthcare companies. The Department of Justice (DOJ) and the U.S. Department of Health and Human Services (DHHS) are working together with state officials to actively investigate and charge individuals suspected of committing home health fraud.

Recent Examples

  • In April 2016, the owners of four Dallas-area home health services agencies were found guilty of participating in a large-scale home health fraud scheme engineered by a single doctor, who was also found guilty of fraud. The scheme, which involved nearly 11,000 Medicare patients and almost $400 million worth of false claims, targeted low-income Medicare recipients who were promised cash and groceries in exchange for compliance with the fraud. For their part, the home health service agencies were accused of recruiting patients for the fraud through such means as door-to-door solicitation, visiting homeless shelters, and buying recruits meals at McDonald’s. Three of the agencies’ owners were each convicted of multiple counts of healthcare fraud and conspiracy to commit healthcare fraud, with each count carrying a penalty of up to ten years in prison and a maximum fine of $250,000. Three other individuals charged in the scheme pled guilty before trial, including two co-owners of a home health services agency that are each serving a ten-year sentence and have been ordered to pay a $25 million fine. https://www.justice.gov/usao-ndtx/pr/dallas-doctor-and-three-dallas-area-home-health-agency-owners-convicted-running-large
  • In February 2016, an Illinois woman was sentenced to five years’ probation and a $1,292.62 fine for improperly billing Medicare for providing 111 hours of home health services to her mother that she did not actually provide. The investigation into the woman began after her mother was found at home alone in an incoherent state and covered in dried feces. https://www.justice.gov/usao-sdil/pr/granite-city-woman-sentenced-healthcare-fraud
  • In August 2015, federal authorities arrested the CEO of a Chicago home health services company after concluding an undercover sting operation designed to catch the home health company red-handed for fraudulent billing and improper certification practices. In the sting, a physically capable 71-year-old informant posed as a patient and received certification as “homebound” as well as multiple allegedly unnecessary house calls from the home health provider. https://www.fbi.gov/chicago/press-releases/2015/ceo-of-chicago-based-health-care-company-charged-with-billing-medicare-for-phony-and-non-existent-treatment-of-the-elderly-in-1.2-million-scheme

What Should You Do If You Are Being Investigated?

Call Dr. Nick Oberheiden at 1-800-810-0259! If you are being investigated for home health fraud, or have reason to suspect you are being investigated, you should contact us immediately. Home health fraud changes may be civil or criminal in nature, and hiring an experienced defense attorney may help you avoid criminal charges in lieu of civil penalties, such as fines or restitution. An experienced attorney will also advise you on how to avoid self-incrimination during the investigation and how to avoid incurring additional related charges such as obstruction of justice or perjury.

Our Experience

At Oberheiden & McMurrey, LLP, our experienced defense counsel and former federal prosecutors routinely receive calls from clients around the country for assistance in their times of need. The strength of the firm is based on three prongs: our industry knowledge, our government experience, and our ability to keep investigations from becoming criminal.

  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.

Our Team

  • Dr. Nick Oberheiden has successfully defended healthcare executives, physicians, and pharmacies against kickback, prescription fraud, false claims, and fraud allegations before the Office of Inspector General (OIG), Department of Justice (DOJ), Department of Defense (DOD), IRS, FBI, DEA, and other agencies. He is trained in negotiations by Harvard Law School and he received his Juris Doctor from UCLA School of Law as well as a PhD in law from the University of Heidelberg.
  • Attorney Lynette S. Byrd focuses her practice on civil and criminal litigation, Medicare and insurance audits, and general advice and counseling in health care law. She is a former Assistant United States Attorney with years of substantial trial experience under her belt who merges excellent litigation skills with profound understanding of the law.

Free Consultation

If you would like to talk to someone who understands how to effectively defend against government investigations, you should consult with former federal prosecutor Lynette S. Byrd of Oberheiden & McMurrey, LLP. All inquiries are free and confidential.

Oberheiden & McMurrey, LLP
Criminal Defense – Healthcare Law – Litigation
(800) 810-0259
(214) 469-9009
www.federal-lawyer.com
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.
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