Many people rely on home healthcare services. It could be people who have had surgery and are trying to recover, people who have an illness and can’t perform the daily activities without assistance or elderly individuals who don’t want to go to a nursing home but need assistance with things like bathing, changing clothes or even cooking. Unfortunately, there are ways to commit home healthcare fraud. If you are charged with doing something like this, it’s important to contact an attorney as you could face criminal charges by the company that you work for as well as a civil suit by the person’s family.
When home healthcare providers commit fraud, they are violating the False Claims Act. Workers often have to bill government programs in order to get compensation for the services that are provided. An example would be to bill Medicare for providing services for an elderly individual who needs help with breathing treatments. The person might claim that the services that are provided costs more than what they really are, which would mean that the worker and the company would end up getting more money.
Another way that home healthcare workers commit fraud is by doctoring paperwork and claiming that someone who is not eligible for healthcare services is eligible. This is often easy to do as all the worker has to say is that the person needs the assistance of someone else. The paperwork can state that the person can no longer provide proper care and that the family requests that someone be in the home. However, the client might not really need those services and can provide care alone, resulting in money being paid to the healthcare company in a false manner. A qualification for receiving home healthcare through Medicare is that the person must be home-bound. This means that the person is unable to get out of the home without assistance. It also means that the person can’t do the basic tasks every day without some kind of help. It doesn’t mean that every task can’t be completed but that the majority requires some type of help, such as getting in and out of the shower or cleaning the home.
Home healthcare agencies can bill for medical procedures that aren’t needed. The worker might request that a service needs to be provided for the client without receiving the treatment and instead keeping the money that is set aside. Each treatment that is given requires a code to be entered on paperwork that is turned in for billing. Some codes are similar, but one might result in getting more money for the company. This is a way that many workers commit fraud as the only thing that needs to be done is to enter a different code on the paperwork. If you pay for or receive kickbacks for any kind of referrals from the patient or the family, then you’re in violation of the Federal Anti-Kickback Statute. This is a way for the company as well as the worker to make money since a bonus is likely given to workers who increase the caseload for the business.
Another way that home healthcare workers often commit fraud is by entering into improper financial relationships with others who provide healthcare. This could be a doctor or a nurse who provides care for the client. The worker would talk with the provider to come up with a way to get more money from the client or the insurance company that is paying for the services. The extra money would be divided between the provider and the worker so that both get more money. An attorney can look at ways to get charges that are brought for healthcare fraud reduced. Most of the time, this is a crime that results in heavy fines, a jail sentence or probation.