Federal Home Healthcare Fraud

Medicare is a federal healthcare program providing benefits to individuals who are over the age of 65 or disabled. “Part A” of the program covers certain eligible home healthcare costs for medical services provided by a home healthcare agency (HHA) to beneficiaries requiring home health services because of an illness or disability causing them to be homebound. Home Healthcare Agencies that provide services to Medicare beneficiaries are able to file claims with Medicare to obtain payment or reimbursement for lawfully provided services.

The Medicare program pays for home healthcare services only if the patient qualifies for home healthcare benefits. A patient qualifies for home healthcare benefits only if:

  • The patient was confined to the home, also referred to homebound;
  • The patient was under the care of a physician who specifically determined there was a need for the home healthcare and established a “Plan of Care”; and,
  • The determining physician signed a “certification statement” that contained all the required elements.

Clients associated with home healthcare programs are sometimes Investigated or charged with home healthcare fraud. Typically, the charge is Conspiracy to commit Healthcare Fraud in violation of 18 U.S.C. Section 1349. The Government in broad terms will allege that the accused conspired with others to execute a scheme to defraud Medicare by means of material false representations in connection with the delivery of and payment for Medicare benefits, items and services.

The Government will often allege that it was the purpose of the conspirators to enrich themselves by,

  • Submitting false and fraudulent claims to Medicare;
  • Concealing the submission of false and fraudulent claims to Medicare and the receipt and transfer of proceeds from the alleged fraud; and
  • Diverting proceeds of the fraud for the personal use and benefit of the alleged conspirators.

Some Home Healthcare Programs engage in fraud. Certainly, that is not true of the vast majority of home healthcare programs that provide legitimate home healthcare to homebound individuals. Sometimes honest, law-abiding home healthcare employees work for a company that has engaged in fraud, and the employee had no knowledge or involvement with the alleged fraud.  A nurse providing honest home healthcare services may be completely unaware that her employer is engaged in fraud.

I have defended many clients who have been investigated or charged with Home Healthcare fraud. These are very serious federal charges and they must be taken seriously. The key to victory as in any case is preparation and hard work. If you are under investigation or charged with home healthcare fraud and you would like me to represent you in federal court , call me at 713-655-7400.

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