Home Healthcare Services Fraud

A New York City Defense Attorney Explains Home Healthcare Services Fraud

Medicare provides payment for home healthcare if patients are confined to their homes. Home health agencies (HHAs) are paid a predetermined rate for services, which are defined to include a 60-day episode of home care. The number of visits and type of visits required during each 60 day period is determined based on service use, patient diagnosis, and functional capacity. In addition to Medicare, other insurers may also provide some coverage for home health services.

Because home health services are billed to the government or private insurers, those who offer and charge for these services are expected to be honest in all information provided. Making material misstatements or omitting relevant information can be considered a form of healthcare fraud. Home healthcare services fraud is a serious crime, which may be in violation of both state and federal law. Both civil and criminal cases may be brought against healthcare agencies and others involved in a scheme to defraud.

If you or your organization is charged, you need to ensure you develop a solid legal strategy as soon as possible for responding to all accusations against you and all legal problems you face. Bukh Law Firm, PLLC has an in-depth understanding of complex rules related to the home healthcare market. Our New York criminal law firm can offer you the representation you need to fight against accusations and reduce the possibility of serious penalties. Give us a call right away so we can get started on your defense.

Examples of Home Healthcare Services Fraud

In order for home healthcare services to be covered, beneficiaries must either be homebound or must be confined to an institution which is not a hospital, a nursing facility, or a skilled nursing facility. Patients must also be in need of one or more specific services including occupational therapy, speech language pathology, skilled nursing, or physical therapy.

Billing for home healthcare services when a patient does not meet criteria can be considered home healthcare services fraud.Billing for more services than a patient should be covered for can also be considered illegal fraudulent claims against the government. Examples of some of the different types of fraud include:

Treating and billing for services for patients who are non-compliant or who have not had their homeward bound status certified.
Billing for unnecessary services.
Manipulation of assessment forms used to determine the services a patient is entitled to, so more services will be paid for than should be covered.
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Federal laws also strictly prohibit kickbacks or payments of any type for referrals. This means that home healthcare services fraud extends to situations where patients, hospital discharge planners, or home care coordinators are offered any benefits in exchange for referring patients for services. Even offering things like 24-hour nursing coverage to adult care homes can be considered an illegal kickback if the services are performed for purposes of inducing referrals.

Penalties for Home Healthcare Services Fraud

Penalties for home healthcare services fraud will vary depending upon whether the fraud involved improperly billing for services or improperly paying or receiving kickbacks. Healthcare fraud and health insurance fraud of all types can result in prison time for those involved if the federal government prosecutes defendants under statutes including 42 U.S. Code 1320a-b (related to false claims for benefits from federal health programs).

Civil litigation is also common when home healthcare services fraud occurs. The Federal False Claims Act allows whistle blowers who come forward and make claims to receive a portion of any money that is recovered that the government paid out as a result of fraud. Whistle blowers thus have tremendous incentive to file cases called qui tam lawsuits alleging wrongdoing.

How a Healthcare Fraud Lawyer Can Help

Bukh Law Firm, PLLC understands how to help you fight to avoid penalties on the state and federal level. Our goal is to provide you with the representation you need to create a legal strategy aimed at addressing all civil and criminal cases brought against you so you can minimize consequences and penalties. Whether we fight to get you a not guilty verdict or negotiate a favorable plea deal on your behalf, we’ll work hard to get the best outcome possible for you under the circumstances. Call today to schedule a consultation and learn more.