Whistleblowers have helped combat home health fraud is by bringing qui tam lawsuits under the federal False Claims Act alleging the Home Health Agencies (HHA) billed government health care programs for home health services provided to unqualified Medicare and Medicaid beneficiaries. Medicare has strict regulations that require patients to have certain medical ailments before it will pay for home health benefits. If an HHA knowingly provides home health services to an unqualified individual, it will have committed home health fraud (i.e. Medicare fraud) and would be liable under the federal False Claims Act.

Federal regulations provide that Medicare will only lawfully pay for home health services if the patient is:

(a) homebound;

(b) under the care of a physician; and

(c) in need of skilled nursing services on an intermittent basis or physical or speech therapy, or is in need of continued occupational therapy after eligibility for home health services was established by a prior need for one of the other qualifying services.

Because the above requirements constitute conditions of payment for home health services, Medicare will not pay claims for home health services knowingly provided to unqualified government health care beneficiaries. Therefore, it is home health fraud and a violation of the federal False Claims Act for an HHA to provide home health services to patients it knows do not qualify for such services under Medicare’s regulations.

Providing home health services to unqualified individuals typically occurs when an HHA provides home health services to a non-homebound Medicare beneficiaries. If an HHA’s patient is not homebound, the HHA is prohibited for billing Medicare for the services provided to that patient. The HHA will have committed home health fraud in violation of the federal False Claims Act if it knowingly submitted and received payment for claims from federal government health care programs (e.g., Medicare, Medicaid, Tricare) for home health services it provided to non-homebound patients.

No Fees Without Recovery

Ross M. Wolfe and the Weiser Law Firm litigate whistleblower lawsuits on a contingent fee basis, so whistleblowers do not pay attorneys’ fees or court costs unless there is a recovery.

Please contact Ross M. Wolfe if you would like to speak with a whistleblower attorney for more information about the whistleblower process, providing home health services to unqualified individuals or to schedule a free confidential consultation to discuss your potential case.