Home health companies are increasingly popular among families who want their loved one to receive care in their own home or another residential location with others receiving care. Home health options are appealing to those who do not favor the traditional nursing home facilities and find them to seem institutional. One advantage of a traditional nursing home setting may be the close monitoring and control of the healthcare professionals who work with residents. Too often the news reports include stories of home health operations failing their residents and failing the system. There are cases of negligent care and abuse of home health residents as well as cases of fraud and financial deceit. When individuals are tempted by the chance to get a little extra from the government, that little extra tends to become more. Many caught in home health fraud schemes are able to take significant amounts of money before they are stopped. How would you know your loved one was cared for by individuals engaging in home health fraud? What questions about the quality of care would keep you up at night?
Is there a way to know whether home health care givers are honest and trustworthy?
When choosing in home healthcare options, it is important to do your research and conduct due diligence by investigating the backgrounds of the individuals who may be caring for you or your loved one. For less than 100 dollars you can obtain background investigative reports for home health professionals. Professional licenses can be verified and in the process, any reports of discipline of that professional may be available. If you are not comfortable or particularly skilled at online investigation, our law firm can assist you or recommend another who may be better able to help you in the vetting process. Unfortunately, it may be difficult to tell whether the individual of any character is engaged in or connected to a fraudulent operation.
Medicare billing fraud cases are reported frequently and investigations lead to convictions.
When people picture Medicare fraud, the image may be a dark basement with leaking pipes and a crooked looking person working at a desk with a sinister look and laugh. In reality, the setting may be right outside your window or down the street. The suburban landscape is ripe with reports of home health fraud. In Schaumburg, Illinois, a 47 year-old woman was convicted on 21 counts of fraud and making false statements; and sentenced to 72 months, with an order to pay 15.6 million dollars in restitution. “Home-health fraud has become a significant problem nationally and particularly in the Chicago area,” Assistant U.S. Attorney Stephen Chahn Lee argued in the government’s sentencing memorandum. “Such fraud cannot happen without people like the defendant, who abuse Medicare’s rules and abuse the trust placed in them by Medicare and their patients.[i]”
Examples of Medicare billing fraud.
In this recent fraud case in Schaumburg, the woman leading the fraud directed her employees to conduct in-home visits for patients who did not need care, people who were not home-bound and quite able and otherwise healthy. When the employees billed Medicare for the visits, they billed for the more expensive and complicated levels of care, even though no care was needed or often performed. The inflated billing and billing for services not needed is an easy fraud to hide if nobody is looking.
Billing Medicare for services not actually needed or performed is such big business that some fraud operations offer kickbacks to individuals who recruit and sign up new home health patients, regardless of their health condition, so long as they qualify for Medicare services and a bill for something can be generated.
How do the frauds become exposed, investigated and stopped if nobody is looking?
Whistleblowers lead to investigations and convictions for home health fraud where Medicare is duped into paying for services never needed or rendered. If one of the nurses working for the woman leading up the Schaumburg fraud scheme was the whistleblower and reported the fraud to authorities, that person would be paid a part of the restitution ordered, in this case that would be a cut of the more than 15-million-dollar restitution.
If you or someone you know suspects others are profiting from home health fraud, you can contact our law firm by dialing 773-631-4580 to learn about your rights under the law and whether you may be able to stop a home health operation engaging in fraudulent practices.
Michael V. Favia & Associates, P.C. is a health law and litigation firm in Chicago representing individuals, healthcare professionals and organizations with civil legal matters as well as professional licensing and regulation. We frequently publish information and resources to help healthcare professionals and individual consumers more knowledgeable about news and occurrences in health.
Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent private individuals as well as healthcare professionals in all types of litigation and administrative matters involving licensing and regulatory agencies.
Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates, call us at (773) 631-4580, please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.
[i] eNews Park Forest, Head of Schaumburg Home Health Company Sentenced to Six Years for Scheming to Fraudulently Bill Medicare for Unnecessary Care, Chicago ENEWSPF, July 26, 2016.
Today’s interview with healthcare consultant, Craig Evans, focuses on healthcare information technology and revenue cycle management. In the patient billing and payment systems there are opportunities to increase efficiency and return on investment which can also benefit healthcare providers with regulatory compliance and reducing the risk of errant and fraudulent medical billing through the implantation of proper healthcare practice management software.
Law Firm of Michael V. Favia & Associates in Chicago 