Access Care, Patient Care, Hands on Healing and All State: Four Agencies and the People Behind the Billing

The Access Care home health fraud appeal described a Michigan network that billed Medicare $47,219,535 and received $40,488,107. The Sixth Circuit’s criminal opinion identified four agencies and a nominally owned staffing company.

Access Care, Patient Care, Hands on Healing and All State were the agencies in the case. For a staffing or billing insider, the ownership question is concrete: whose name was on the business, and who directed the work?

We follow both the clinical decisions and the people controlling the money. A patient file explains what care an agency claimed to provide. Staffing and financial records help explain who supplied the workers, who directed the work and where the payments went. In a network, those accounts need to be read together.

Paper Owners and the People in Charge

The criminal opinion’s account of a nominally owned staffing company puts paper ownership beside actual control. For an ownership or billing insider, the useful distinction is between the person named on the paperwork and the person making the decisions.

In a business that uses a staffing contractor, the agency bills Medicare while the contractor supplies clinical staff. The agency that billed Medicare answers for the staff it hired in. The staffing relationship therefore belongs beside the patient record when we examine what the agency billed.

We compare who directed employees with who controlled the payments. We want to understand how those roles fit the same claims.

The Clinical File Behind the Claim

The home health certification chain connects the patient’s eligibility and ordered care to the agency’s assessment, visits and bill. In a business with several agencies and a staffing contractor, that chain also connects records held by different people.

The certifier’s medical record or the discharging facility’s record supports eligibility. The care plan identifies the services, visit frequency and duration. The agency assessment and visit documentation describe the patient and the care delivered. An employee who saw the original clinical finding can explain what changed before billing.

The financial end is equally specific. Medicare’s claims-processing manual describes how assessment information, diagnoses and visit lines feed payment. The remittance records what Medicare actually paid after adjustments.

What Are Some Examples of Home Health Care Fraud?

Paid recruitment, payments for physician certifications and fabricated therapy records show how different parts of the home health business can feed false claims. Other prosecutions make each mechanism visible.

In a guilty plea, the owner of TLC Healthcare Services of Illinois Inc. admitted paying recruiters for Medicare patients. The Justice Department’s account describes sham marketing contracts accompanying payments of $500 to $600 per patient. This is patient recruiter fraud with an ordinary business label attached. The payment followed the patient delivered to the agency.

The physician’s signature could be bought separately. In the criminal case involving a physician who certified patients for Grand Home Health Care, the court described payments for admission and recertification forms. The patients needed home health care and chose the agency independently. The certification payments still supported the physician’s kickback convictions. We see the absurdity: the patients needed care, and the physician sold the signature.

The clinical record itself could be manufactured. In the separate Patient Choice Home Healthcare Inc. and All American Home Care Inc. prosecution, the Justice Department’s account of trial evidence described beneficiary-signed blank forms becoming fictitious therapy records. A signature supplied before the supposed therapy account was written gave invented care the appearance of confirmation. The recruiter invoice, certification payment and therapy note describe different decisions that can converge on the same claim.

Why the Therapy Payment Period Matters

The Access Care network’s criminal appeal predates Medicare’s switch to the Patient-Driven Groupings Model. Older home health payment rules used therapy-volume thresholds that could increase payment for an episode. That history matters when unnecessary home health care concerns visits added to reach a payment category.

Medicare’s replacement payment rule moved payment to patient-based 30-day periods on January 1, 2020, removing therapy-volume thresholds. For someone who worked through that change, an old therapy tally and a newer assessment can explain different payment decisions. We connect the instruction staff received to the clinical record and the payment it affected.

What Evidence Is Needed to Prove Fraud?

The useful evidence connects the false clinical or financial account to the people who directed it and the claim Medicare paid. In a network case, that means following the work across agency and contractor records.

For a clinician, the connection may be an original assessment, an instruction to change it and the revised version used for billing. For a billing employee, it may be the visit lines submitted and the corresponding remittance. For someone handling staffing or finance, it may be the link between the agency’s payment, a contractor’s invoice and the person actually directing the workers. We use the financial records to connect the people directing the business to the clinical decisions and claims.

Your knowledge can supply the connection between records that look unrelated to someone outside the agency. Knowing who ordered a change, what the original entry said and how the altered account reached billing gives us something specific to investigate with you.

How Much Does Medicare Fraud Whistleblower Pay?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. For someone seeing a similar pattern inside a home health agency, we assess the potential civil case around the claims, payments and decisions they can explain.

You Know Who Directed the Work

If the agency name, staffing invoices and patient files tell different stories, bring that inside knowledge to our whistleblower experts. We work with you to identify who controlled the claims and the money, build your home health fraud case, and bring in healthcare fraud whistleblower lawyers who understand agency networks. You have a partner from the first account of what happened through the pursuit of a recovery.