Home health care providers perform important services for elderly, disabled, and other patients who need services provided in-home. However, like some hospitals, some home health care providers put their desire to maximize profits ahead of the interests of patients and taxpayers.
Home health care providers can defraud the government and violate the False Claims Act in nearly countless ways. One way home health care providers may attempt to defraud the Government is by billing government health care programs for services provided to patients who do not meet the qualifications for home health care under those programs. One important qualification under Medicare for payment of home health care services is that the patient must be certified as homebound. In general, a patient is considered homebound if leaving their home requires considerable and taxing effort or if it is not recommended that the patient leave home because of their condition. A home health care provider submits a false claim when it bills Medicare for services provided to a patient that is not actually homebound.
Some of the other types of fraudulent schemes that home health care providers may engage in include:
- Billing for medically unnecessary procedures
- Billing for procedures not actually performed
- Providing incorrect billing codes for the purpose of increasing reimbursement (i.e., upcoding)
- Paying or receiving kickbacks for referrals of patients and services in violation of the Federal Anti-Kickback Statute
- Engaging in improper financial relationships with other health care providers who refer patients in violation of the Stark Act
- 2012: Odyssey Health care, a subsidiary of Gentiva, paid $25 million to resolve civil liability under the federal False Claims Act arising from its billing of claims for certain hospice services. The settlement resolved allegations that Odyssey performed continuous home health care services for palliative hospice care that were unnecessary or that were not performed in accordance with Medicare requirements between January 2006 and January 2009. Odyssey had submitted claims for continuous home care services at the highest reimbursement rate rather than for routine care level of service, which would have been justified. The continuous home care services reimbursement rate was higher than the routine care rate by several hundred dollars per day, per patient. The whistleblowers, all former employees of Odyssey, received payments totaling more than $4.6 million for their action.
- 2011: LHC Group Inc., one of the largest home health care providers in the United States, paid $65 million to settle claims that it submitted false claims to the government when it billed government health care programs for non-medically necessary services and for services provided to patients who were not homebound. The whistleblower received over $12 million as his share of the recovery.
- 2011: Hospice Home Care, Inc. paid $2.7 million to settle a lawsuit filed by whistleblower under the False Claims Act in which it was alleged that the company overbilled Medicare by billing for a higher level of care than that which was actually provided or required.