Home Health Services Whistleblower

We Help Whistleblowers Expose Medicare and Medicaid Fraud in the Home Health Services Industry

Home health care fraud, including Medicare fraud in the home health services industry, is a major problem. According to government data, more than half of all Medicare payments to home health care agencies (HHAs) show signs of fraud. Medicaid fraud is a major problem as well, and the government relies heavily on HHA employees and others to come forward when enforcement action is warranted. 

At Oberheiden P.C., we represent home health services whistleblowers nationwide. If you are aware of your employer, your former employer, or another company improperly billing Medicare or Medicaid, you may be eligible to report the fraud or pursue False Claims Act allegations. The False Claims Act prohibits fraud under federal health care programs (including Medicare and Medicaid), and it provides strong protections to those who come forward. 

All-Too-Common Forms of Home Health Services Fraud 

When should you think about serving as a home health services whistleblower? There are many forms of fraud committed by home healthcare providers, and all of these forms of fraud can warrant filing a whistleblower claim with the federal government. Some all-too-common examples of home health care services fraud that we help whistleblowers report include: 

Billing for Home Health Services Provided to Patients Who Are Not “Homebound”

Under Medicare’s billing rules, home health services are only eligible for reimbursement when they are provided to patients who are “homebound.” To qualify as homebound, a patient must either:

• “Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person to leave their place of residence;” or, 
• “Have a condition such that leaving his or her home is medically contraindicated.”

Additionally, the patient must both: 

• Have a “normal inability to leave home;” and, 
• “[R]equire a considerable and taxing effort” to leave home. 

If these requirements are not met, the patient does not qualify to receive home health services that are reimbursed through Medicare. If an HHA bills Medicare for home healthcare services provided to the patient anyway, the HHA can (and should) be held accountable for fraud. 

Billing for Home Health Services Provided to Patients Who Do Not Have a “Skilled Service Need”

Even when a patient is homebound (as defined by the Medicare billing regulations), HHAs can only provide in-home services that satisfy a “skilled service need.” Skilled services include skilled nursing services, physical therapy, occupational therapy, and speech-language pathology services. Additional restrictions apply as well; and, here too, if an HHA does not strictly comply with the requirements for Medicare (or Medicaid) eligibility, then a whistleblower complaint will most likely be warranted. 

Billing for Home Health Services Without a Physician “Plan of Care” 

Under Medicare’s billing guidelines, all home health services must be provided in accordance with a “plan of care” established and periodically reviewed by the patient’s physician. If a patient does not have a plan of care, if a physician wasn’t involved in establishing the patient’s plan of care, or if the patient’s plan of care is not periodically reviewed, all of these are issues that a home health services whistleblower can report to the federal government. 

Billing and Coding Fraud Under Medicare and Medicaid 

Along with these issues that are specific to billing for home health services, HHAs can be held accountable for many other forms of billing and coding fraud as well. For example, we strongly encourage you to speak with a whistleblower lawyer at Oberheiden P.C. if you have information about: 

• Unbundling or upcoding 
• Billing for home health visits not conducted
• Billing for home health services that are not medically necessary 
• Billing Medicare or Medicaid for services provided to patients who are not enrollees 
• Falsifying patient records, orders, medical forms, or other documents 
• Falsely certifying compliance with Medicare’s home health services requirements 
• Forging physician or patient signatures 

Again, even these are just examples. Regardless of why you have concerns about fraud, you should talk to a lawyer about what you know, and you should rely on your lawyer’s advice to make informed decisions about your next steps. 

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Hon. Kevin McCarthy

55th Speaker, U.S. House of Representatives (ret.)

Government Consultant

Mike Pompeo

Of Counsel

Former U.S. Secretary of State

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Nicholas B. Johnson

Former Prosecutor

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

5 Important Facts to Know About Blowing the Whistle on Home Health Services Fraud 

If you decide that you want to blow the whistle on home healthcare fraud, what do you need to know about serving as a whistleblower under the False Claims Act? Here are five important facts for potential home health services whistleblowers: 

1. The Process Starts with a Free and Confidential Consultation 

The process of serving as a whistleblower starts with talking to a lawyer who can help you. Your initial consultation is completely free and confidential. It is also completely without obligation. When you talk to a lawyer at Oberheiden P.C., you are under no obligation to move forward with blowing the whistle. Our job is to help you make an informed decision and then provide legal representation if you choose to come forward.

2. Our Whistleblower Lawyers Provide Representation at No Out-of-Pocket Cost

If you choose to come forward, we will represent you at no out-of-pocket cost. We do not charge whistleblowers any legal fees or costs during the course of our representation. If we help you secure a whistleblower reward from the federal government, our legal fees will be paid out of the funds you helped the government recover. 

3. Whistleblowers are Entitled to Confidentiality and Protection Against Retaliation 

When you qualify as a whistleblower under the False Claims Act, you are entitled to confidentiality and protection against retaliation. While it is unlikely that your employer will uncover your identity, if it does, it will be prohibited from taking adverse employment action against you. If your employer violates this prohibition, you will be entitled to clear remedies.

4. Filing a Whistleblower Complaint Could Lead to a Financial Reward

Under the False Claims Act, home health services whistleblowers who help the government pursue a successful enforcement action are generally entitled to receive between 10% and 30% of the amount the government recovers. If you become entitled to a whistleblower reward, our lawyers can assist you with claiming it from the government. 

5. Exposing Home Health Services Fraud is the Right Thing to Do

Finally, and most importantly, exposing home health services fraud is the right thing to do. Whistleblowers play a critical role in the ongoing fight against fraud, waste, and abuse in government funded insurance programs. If you can help the government put a stop to fraudulent Medicare or Medicaid billings for home health services, doing so will benefit patients, taxpayers, and the general public. 

FAQs: Serving as a Home Health Services Whistleblower 

Further Information About Our Home Health Services Whistleblower

• Whistleblower Lawyers
• Pediatric & Caregiving Home Health Whistleblower