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Recent Federal Investigative Activity on Home Health Agencies

Wednesday, March 20th, 2019

by: Bradley W. Howard

Several recently issued federal indictments in Florida, Missouri and Virginia all tell the same story: Home Health Agencies, their owners and employees have been charged with health care fraud counts premised on the agencies billing Medicare or Medicaid for home health services that were not actually provided to home-based patients in need.

The defendants in all of these cases were authorized to provide patients assistance with activities of daily living and/or instrumental activities of daily living, including meals, the cleaning and grooming of patients, and medication management. Because Government programs use the time spent providing appropriate personal care services when calculating the amount of reimbursement from the appropriate Government agency, the accuracy of records regarding when and what types of personal care services were performed is essential. The Government is not there in the patient’s home to verify that services were provided as represented by the home health providers, but based on appropriate documentation the Government regularly issues such payments.

In these recent cases, the Government charged various individuals with health care fraud and conspiracy for failing to provide services as represented by the home health agencies to the Government. The charged individuals include employees accused of billing for time they could not have been working because they were out of state or, in some cases, out of the country on the day the services were supposed to be provided. Further, owners were charged on the grounds that they billed the Government for home health services that could not have been provided when the employees were out of town.

There are a few takeaways for home health agencies from these cases recently filed by the Government. First, the Government through its contractors is carefully watching billings for home health services to ensure that they are completely accurate. That has always been the case, but these cases emphasize that owners are being scrutinized for services they bill based on the certified therapy notes of aides who work for them. Second, home health agencies need sufficient controls in place to ensure that the services being billed were provided just as described. This type of vigilance requires monitoring of employees and contractors and internal auditing to ensure completely accuracy in billing. Finally, home health agencies must train and retrain their aides to ensure that everyone operating under the banner of the home health agency understands and fulfills their legal obligations to certify only those services that were actually provided on that date to beneficiaries. There is no margin for error when the Government investigators believe that errors are not simply mistakes but instead healthcare fraud. There are enough questionable operators to draw the Government’s attention to all providers in the home health industry.

Bradley W. Howard is a member of a team at Brown & Fortunato, P.C. that routinely represents home health and hospice businesses on a broad spectrum of corporate, regulatory, operational issues and investigations. You can reach Brad Howard at bhoward@bf-law.com and the Home Health and Hospice team at Brown & Fortunato at 806-345-6310.