The rising cost of healthcare and nursing facilities caused an increase in the popularity of home healthcare facilities, where disabled and elderly patients can receive appropriate levels of care. While many people benefit from the home healthcare option, many may also find ways to defraud the system. Billions of dollars a year lost to home healthcare fraud lead to increased healthcare costs and insurance premiums. From federal investigations and search warrants served on residential facilities where fraud is suspected, to the investigations of the Medicare Fraud Strike Force, there are increasing news stories involving fraud and the measures necessary to prevent and stop abuse of the system.
The FBI released a recent home healthcare fraud story:
“The husband-and-wife owners of a Chicago home-healthcare business paid kickbacks to employees and marketers in exchange for referring elderly and disabled patients to the company for unnecessary or non-existent treatment that was funded by Medicare, according to a 23-count federal indictment unsealed today.[i]”
Kickbacks to employees and marketers for patient referrals is a common problem and area of abuse in home healthcare. There are many more activities the experts in law enforcement study in an effort to isolate fraud. Since whistle blowers are able to share in the criminal penalties received in some fraud cases, there could be more eyes on home healthcare operations, including friends and neighbors who hear stories about home healthcare fraud. In some instances, honest and legitimate home healthcare providers could be reported to authorities. Defending against charges of fraud can involve documentation, effort and legal representation.
Common examples of home healthcare fraud are both due to knowing wrongdoing and negligence.
- Billing and Claims Fraud: Sending a reimbursement claim to Medicare for services never received, exaggerated patient conditions, unnecessary services and false timesheets for healthcare providers are common billing and claims fraud activities. It is important to keep accurate and correct records of everything. Home healthcare workers should always ask whether they would be able to back up all their billing and claim submissions.
- Fraudulent Accounting: When home healthcare operations cut corners in accounting and bookkeeping, their activity could look like an effort to avoid tax liabilities or earn more credits than actually earned. It is a good idea to keep an extra backup of all accounting and obtaining a C.P.A. review and audit is a smart and proactive measure.
- Elder and At Risk Patient Abuse: The family of home healthcare patients are frequently notified by news stories about elder abuse that even their loved one may be at risk. It is vitally important to document any injuries to a patient, even if they bump into a wall and bruise an arm. Home healthcare workers may earn lower wages, have minimal training, and experience high turnover, so it is important for managers of home healthcare operations to be present and knowledgeable about everything going on in their facility.
- Background Check Fraud: Where background checks are required by Medicare, for example, an industry-standard or specifically identified process must be used to verify the criminal and healthcare background of home healthcare workers. Cutting corners and missing a past felony in a state one did not think to check could lead to worse problems. Home healthcare managers attempting to avoid liability for negligence should always perform and document the best reasonable industry required background check.
- Patient Recruitment Kickbacks: Paying employees and contractors to solicit patients is not allowed by the Medicare system and any home healthcare worker pulling homeless people off the street or placing individuals in home healthcare who do not legitimately need that level of care are likely to be convicted of fraud if investigated and caught. Avoiding even the slight appearance of impropriety is important. Proper paperwork used in admitting new home healthcare patients should be adopted as a diligence practice.
- Home Healthcare and Physician Conspirators: When a doctor conspires with a home healthcare operation to write prescriptions, assist with certifications and other operating documentation, everyone involved is exposed to civil and criminal liability. If a doctor is engaged with wrongdoing with another you otherwise do not know, expect the investigators to scrutinize anyone else that doctor has worked with. Being proactive and documenting research on doctors with whom home healthcare operators transact, is an important precaution.
The best way to avoid unnecessary headaches and suspicions or investigations of wrongdoing is to keep all policies and practices well documented and reviewed by appropriate professionals. Michael V. Favia & Associates work with home healthcare operations to make sure they comply with the law and avoid exposure to liability for wrongdoing.
Michael V. Favia & Associates’ offices are conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates’ professional licensing work, please visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.
[i] FBI press releases, Owners and Nurses of Chicago Home Health Care Company Among Seven Indicted in Medicare Fraud and Kickback Scheme, Aug. 27, 2015.
