Expose Illegal Home Health and Hospice Care Practices with Experienced Whistleblower Attorneys

Medicare and Medicaid pay for a wide range of services delivered in patients’ homes or home-like settings, including skilled nursing care, physical and occupational therapy, speech-language pathology, home health aide services, and hospice care. Providers across all of these categories can and do commit healthcare fraud against state and federal healthcare programs. Whistleblowers with inside knowledge of these schemes are often essential to exposing them.

Fraud by home health care providers, like other frauds against the government, is actionable under the False Claims Act. Our team at Whistleblower Partners LLP can help you effectively expose this kind of fraud under the FCA and state private insurance fraud prevention statutes.

What Is Home Health Care Fraud?

Home health care fraud is a broad category that encompasses dishonest billing and patient-care practices by any provider delivering services in a patient’s home or a home-like setting. The most common thread running through these schemes is billing government healthcare programs for services that were not provided, were not medically necessary, or were furnished to patients who did not meet the applicable eligibility criteria. Other typical health care fraud schemes are also common in the home health care setting, such as:

• Overprescribing drugs
• Upcoding
• Billing for services furnished by providers who lack the required credentials
• Kickback arrangements

Because home health services are delivered in private residences and other settings that are difficult for regulators to monitor directly, fraud in this sector is particularly difficult to detect without the help of whistleblowers.

Skilled Nursing Fraud

Skilled nursing services provided in the home, such as wound care, medication management, and IV therapy, are among the most heavily billed home health services under Medicare and Medicaid. Common fraud schemes include billing for skilled nursing visits that never occurred, inflating the number or duration of visits, or falsely documenting that a patient required skilled nursing care when, in fact, only custodial or unskilled assistance was needed. Because skilled nursing services must be ordered by a physician and are reimbursed at higher rates than unskilled care, they are a frequent target for fraudulent billing.

Physical, Occupational, and Speech Therapy Fraud

State, federal, and private insurers may also cover physical therapy, occupational therapy, and speech-language pathology services in the home. Fraud in this area often takes the form of billing for therapy sessions that were not provided, documenting more therapy minutes than were actually delivered, or fabricating progress notes to justify continuing therapy for patients who have already reached their maximum recovery. In some cases, providers may bill for therapy furnished by unqualified aides rather than licensed therapists.

Home Health Aide Fraud

Home health aides assist patients with activities of daily living such as bathing, dressing, and mobility. These aide services are not always reimbursable. Moreover, providers sometimes bill for aide visits that never happened, claim that aides provided more hours of care than they actually did, or bill aide services at the higher rate for skilled nursing. Kickback arrangements, in which aides or recruiters are paid to refer patients to a particular agency, are also common in this sector and can violate both the False Claims Act and the Anti-Kickback Statute.

Hospice Fraud

Hospice care is a type of care focused on the comfort and quality of life of people who are terminally ill. This area of home health is particularly vulnerable to fraud. The most common form of hospice fraud is admitting ineligible beneficiaries into hospice programs and billing insurers for those services. In July 2024, Kindred Care, one of the nation’s largest hospice providers, agreed to pay roughly $20 million to resolve allegations that the company was falsely categorizing patients as terminally ill, and thus eligible for hospice care, when they were not in fact terminally ill. This type of fraud is common; the Kindred Care settlement resolved at least nine lawsuits, all brought by one or more whistleblowers. Similarly, in May 2024, Elara Caring, a hospice provider in Texas, agreed to pay $4.2 million to resolve similar allegations in a case also initiated by a whistleblower. And in 2022, yet another hospice provider paid over $1 million to settle similar claims.

In addition, in July 2024, a Georgia hospice paid over $1.2 million to resolve allegations that its claims resulted from kickbacks.

What Can Whistleblowers Do to Stop Home Health Care Fraud?

Home health care fraud is wasteful for taxpayers and dangerous for patients, and those who commit it may be liable under the False Claims Act, a law that empowers whistleblowers to detect and expose fraud against the government.

Under the FCA, whistleblowers can bring lawsuits against healthcare providers, vendors, and drug companies whom they allege violate the law. As an incentive, whistleblowers can be rewarded 15-30% of the amount the defendant ultimately pays the government as a result of the case.

Whistleblower Partners has secured multiple high-profile wins in this area and can help you assess whether you might have a case. If you would like more information or would like to speak to an attorney at Whistleblower Partners, please contact us for a confidential consultation.