NATIONALLY RECOGNIZED FEDERAL LAWYERS
Last Updated on: 3rd August 2023, 09:15 pm
If you suspect any kind of home healthcare fraud taking place concerning your family members or someone you know, it’s important to find an attorney who will treat you like a part of their own family. Several types of people rely on the services that are offered by a home care service. Aside from elderly individuals who don’t want to go to an assisted living facility or a nursing home, those who have had surgery, people who are disabled, and those who have illnesses that prevent them from leaving home or providing the care that they need for themselves are only some of the ones who can benefit from home healthcare. Since the number of people who need assistance is so large, it means that there are more workers who are needed to provide care. This also means that there are more opportunities for fraudulent acts to be committed. Whether you suspect that home healthcare fraud is being committed or you are the one charged with the acts involved, you should consult with an attorney because of the possible criminal penalties as well as the possible civil lawsuits that could take place.
Home healthcare fraud services committed are in violation of the False Claims Act. Sometimes, a worker or a healthcare company will try to file a bill with a government agency or an insurance agency in order to receive payment for services that aren’t provided by the workers but that are needed by the patient. Unless there is an investigation or someone is monitoring the worker in the home, then the government agency or insurance company making the payment wouldn’t know that the services aren’t being provided. A common example is when home healthcare companies bill Medicaid and Medicare for therapy equipment or breathing equipment but state that the products cost more than what they really are. When the payment is approved, the home care agency would use the correct amount of money for the equipment and keep the rest of the money received.
There is another way that a home care agency can commit fraud and is usually more common with smaller agencies that might not have as many clients as larger agencies. The company will meet with a potential client and state on the paperwork submitted for payment that the person is eligible for services when there is really no need for services in the home. Someone from the agency could indicate that the family is not available to provide the care that is needed or that the family wants home services to be provided because of health issues that prevent the person from performing simple care acts. The need for services is often exaggerated in order for the agency to receive payment. Sometimes, the agency might send someone to the home to check on the person, but in most instances, the company just gets the money and never sees the person again unless the agency is contacted by the family.
Treatments and services that are provided have certain codes that are entered on paperwork that is submitted to Medicare, Medicaid, and insurance companies. There are many codes that are similar and usually only have one number or letter that is different. However, one service might mean more money for the agency than another. The agency will enter the code that results in more money instead of the correct one, making sure that both codes fall under the same category of care. Agencies also receive kickbacks at times for services provided. They could work with doctors and other professionals who submit paperwork for patients to receive home care. When the agency receives the payment for the services, the professional would receive money as well and offer the agency a bonus. These are only some of the examples of healthcare fraud. Agencies that are convicted could lose their license and be shut down. An attorney can assist both families who believe that fraud has been committed as well as those who are accused of fraud, working to achieve a fair outcome for everyone.