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Feds Stay Vigilant for Signs of Fraud in Home Care and Hospice

Garcia & Artigliere

The concept of fraud has become somewhat synonymous with home healthcare and hospice. As a result, the industry is seeing scrutiny from the U.S. Justice Department. There has been a multitude of fraud investigations and judgments within the home care industry thanks to a surge in agencies. Fraud can more easily be committed through these home healthcare agencies.

Therefore, the approval process for new centers in parts of the country is much stricter than it used to be. The government and the home care industry are working together to stymie fraud. Some of the measures taken include making sure there is a cap on various federal payments to agencies. Additionally, data analysis is used to uncover any fraudulent activity.

Within healthcare, home care is an especially appealing sector due to fraudsters being able to take advantage of Medicare and bill for multiple services under “home care.” According to a 2012 report by the U.S. Department of Health and Human Services’ Office of Inspector General, one in four home care agencies had problematic billings in 2010.

Experts say the sudden proliferation of home care agencies added to the issue. For example, home care agencies started ballooning in Florida over 10 years ago. At the time, the state of Florida eliminated a provision that required agencies to obtain certificates of need prior to facility openings. However, high costs followed this decision. In Miami, home care facilities were claiming high rates of Medicare outlier payments.

To combat this, the Health Care Fraud Prevention and Enforcement Action Team (HEAT) was created. HEAT’s Medicare Fraud Strike Force is comprised of local, state and federal investigators and is located in nine major cities. The Medicare Fraud Strike Force has had some major successes in these cities. Miami and Detroit are some of the largest Medicare fraud offenders. By the 2013 fiscal year, 84 people in Detroit were charged with fraudulently billing Medicare for $150 million in claims. In Florida, 202 defendants were charged with being responsible for $570 million in fraudulent claims between 2009 and 2013 (fiscal years).

It’s important to stop fraud and other abuses when it comes to seniors and healthcare. Elder abuse is happening on a multitude of levels. To learn more about Garcia & Artigliere’s compassionate lawyers and their success stories, visit our website. Call us with your concerns or a case evaluation at 800-281-8515. You can submit a free case evaluation online via our website as well.


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