Pro Healthcare Servicing: Referral Payments and the Promise of a Lawful Business

In the Pro Healthcare Servicing fraud case, the company and two executives agreed to pay $1 million to resolve alleged referral kickbacks and false pandemic-loan certifications. The government said a home health provider paid employees inside care facilities to send it patients, then billed Medicare for their care. On its loan applications, the company allegedly certified that it was not engaged in illegal activity. The referral payments and the applications told different stories about the same business.

Pro Healthcare Servicing, LLC operated as Pro Health, a home health care company based in Fairfax, Virginia. Its chief executive officer and chief administrator joined the company in the settlement.

What Pro Health Was Alleged to Buy

From 2012 through 2021, the government alleged, Pro Health and its executives paid employees at assisted-living and skilled nursing facilities throughout northern Virginia to induce referrals for home-health and hospice services. Pro Health then billed Medicare for services to the referred patients.

The alleged arrangement sent the bills to Medicare. Honest home health providers competing for those patients faced a different contest: the government said employees at the referral source were receiving money from Pro Health.

An insider who knows the arrangement can connect the reason for a payment with the business that followed it.

Why the Referral Relationship Matters

A nursing facility’s operator, its management company and outside service vendors can be separate businesses with different contracts and payment streams. The records of a referral arrangement can therefore sit on both sides of the relationship. In Pro Health’s case, the alleged recipients worked inside facilities while the company obtaining the referrals billed Medicare.

A related allegation appeared in HPH Hospice’s settlement, announced in 2013 for the same settlement amount. The government alleged that the hospice supplied free services to skilled nursing facilities in exchange for referrals. The settlement also covered allegations of ineligible hospice enrollment, delayed discharge, misleading records and inflated levels of care.

The free-services arrangement put the benefit at the facility level. Pro Health’s alleged payments went to employees. Both accounts describe a provider giving something of value to the source of its patient business.

Home health referral data can also reveal patterns across a provider’s business. The National Bureau of Economic Research’s 2026 working paper Medicare Home Health Fraud: How Much, Where, and Who? connected referral sources, care patterns and patient health in its study of Medicare home health agencies:

The study’s finding brings the service records into the referral story. Its focus on unusually uniform care alongside healthier patients gives an insider a concrete question: did the pattern of services follow the patients’ needs, or did the same pattern keep appearing across different patients?

We examine who sent patients alongside the care the provider billed for. A referral relationship has a business history, and someone who worked with those patients may understand a pattern that billing totals alone leave unexplained.

The Separate Pandemic Loan Claims

The Paycheck Protection Program and Economic Injury Disaster Loan allegations concerned false statements on Pro Health’s applications. The government alleged that, while the referral scheme was operating, the company obtained these Small Business Administration loans by falsely certifying that it was not engaged in illegal activity.

The alleged referral conduct mattered in both parts of the case. It was the basis of the healthcare allegations and the reason the government said the loan certifications were false. The applications put the company’s account of its own conduct in writing.

Unified Care Services offers a useful comparison involving a different certification. The government alleged that its Paycheck Protection Program applications and loan-forgiveness requests concealed common ownership, control and affiliate employees. That case turns attention to what the borrower represented about its business and the information behind that representation. In Pro Health’s case, the challenged representation concerned illegal activity.

What Evidence Is Needed to Prove Fraud?

For an alleged referral-payment arrangement, the useful evidence connects the payment, its recipient, the patients referred and the resulting government claims. We work with insiders on those connections between business records and billing, including who controlled the decisions.

We compare what a referral agreement promised with the services actually performed, then trace the payments and resulting patient business through admission, clinical and Medicare billing records. The gap between the stated reason for paying someone and the work they actually did can make the arrangement understandable to someone outside the business.

The loan side calls for a different comparison: the application, the certification and the business conduct behind the answer. In Pro Health’s allegations, that means the company’s statement about illegal activity and the referral arrangements operating at the time. The same payment records can matter to the Medicare allegation and to the truth of the loan application.

An employee may know why a referral went to a particular provider. Someone in accounts may know who received the payment. Someone handling the loan application may know what the company represented. We build the account across those roles, so the payment, the referral and the certification can be understood together.

The Settlement Covered Both Allegations

The Justice Department announced the resolution on March 13, 2023. The company and its two executives agreed to the collective payment to resolve the referral and pandemic-loan claims together.

A whistleblower case under the False Claims Act can pay a whistleblower reward of 15% to 30% of what the government recovers.

You Know What the Referral Payment Bought

If you saw payments tied to patient referrals or handled loan certifications that contradicted the business you knew, speak with our whistleblower experts about building your case. We build your strongest home health fraud whistleblower case with you and bring in healthcare fraud whistleblower lawyers who understand referral payments and false loan certifications. You have our expertise and partnership from the first account of the arrangement through the pursuit of a recovery.