After a nine-year conspiracy, a Houston-based home health agency has finally been brought to justice after defrauding Medicare for over $13 million. It was found that, between February 2006 and June 2015, the agency submitted falsified medical records and paid kickbacks to patient recruiters, physicians, and Medicare beneficiaries in order to bilk Medicare for services that were either medically unnecessary or not rendered at all.
As is widely known, Medicare does not cover all medical services, especially for those who are not deemed eligible to receive them. Home health care is exceptionally difficult to qualify for, as benefits are only offered to those that are homebound and require specific skilled nursing services. In this case, it was found that many of the recipients of the home health agency’s services did not fall into these categories. In order to achieve this, the agency offered kickbacks, or bribes, to physicians who were willing to falsify medical records which certified these patients as eligible for their services – services which were oftentimes not provided whatsoever.
Patient recruiters also took part in this multi-million dollar scheme, accepting kickbacks to refer Medicare patients to the home health agency who would have otherwise been placed in alternate medical care. The recruiters would advocate for the agency, insisting that patients be sent to their specific facility when various alternative, and generally more suitable, options were available.
With the profits that the agency fraudulently received from Medicare reimbursements, patients were also paid kickbacks from both the agency and the recruiters in exchange for the use of their Medicare information. This enabled the agency owners to utilize their beneficiary information to bill for home health services that either should not have been provided or were altogether non-existent.
Home healthcare fraud itself is rampant, and comes in various forms. However, the common denominator between all home health schemes is their targeting of the elderly and most vulnerable citizens for personal gain. The federal government estimates that healthcare fraud amounts to over $80 billion in costs each year. This money is not only coming from the pockets of taxpayers, but is being stolen from a system that already has limited assets. These conspiracies directly contribute to the ever-rising cost of healthcare premiums and the increased regulations that beneficiaries are subject to in order to qualify for services – in turn, fraud robs those who truly need medical care from receiving the support and treatment they deserve.
Whistleblower Justice Network Can Help You
Whistleblower Justice Network partners with whistleblowers across the nation in efforts to expose various healthcare fraud schemes that violate the False Claims Act. Under the qui tam provisions of the False Claims Act, we seek to bring to justice those who take advantage of government-subsidized healthcare programs and recover funds that have been illegally obtained, so they may be allocated to those in need.
If you have meaningful information regarding a home healthcare scheme that you believe is defrauding Medicare or Medicaid, Whistleblower Justice Network can help. Working alongside world-class legal counsel, we will ensure you are protected to the fullest extent of the law and that you receive credit for the information you bring to the U.S. government. Partnering with whistleblowers is all we do. Visit us at www.whistleblowerjustice.net, or call us at 844-WJN-4ALL.