Legal Services Home Health Aides and Helathcare Professionals
Healthcare fraud is the knowing and willful use of wrong information, or omitting information to defraud any health care benefit program, whether public or private. Home health aide services have the highest rate of healthcare fraud out of any other classification of medical services.
Charges of health care fraud are serious and carry with them possibly lengthy prison sentences and hefty fines. In addition to criminal penalties, charges of health care fraud may ruin the reputation of you and your business and lead to civil penalties and lawsuits.
If you feel you or your business are susceptible to charges of health care fraud, contact an attorney today to discuss possible preventative measures you can take and how to best prepare yourself for potential charges or an investigation of health care fraud.
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What is Health Care Fraud?
Health care fraud is illegal under 18 U.S.C. §1347. It is the providing of false information to an insurance provider to obtain money or other property from the provider.
The federal crime requires prosecutors to prove four elements to obtain a conviction for health care fraud. These elements are:
- Knowingly or willingly attempts to execute
The defendant provides knowingly false information, a factual mistake would not suffice. The defendant must intend to falsify information or omit information, then submit it to the insurance company. The provider relies on that information, then sends money or property in return.
As an example, if a home health aide submits hours for billing that he or she did not spend with a patient that would be a knowing and willful act.
On the other hand, if the aide accidentally bills one patient’s insurance company when she meant to bill another patient’s insurance company that may be considered an innocent mistake.
2. A scheme or artifice
3. Through false or fraudulent means
Fraud is the deliberate deception of another to secure some gain or to deprive a victim of a legal right.
Fraud differs from abuse of position as a medical professional or employee. Abuse is an action that is inconsistent with the general practices of the medical industry. Fraud is the exploitation of fact to receive something of value.
4. Obtain property or money from a health care benefit program.
Under 18 U.S.C. §24(b), a health care benefit program is any public or private plan that provides medical benefit, item, or service is provided to any individual or provides the payment for those things.
There is no knowledge of, or intent to violate, the federal statute necessary. By providing an insurance company with false or misleading information and receiving property based on that false information, you may be held liable for fraud.
Further, this federal statute is broad, and applies to all licensed and non-licensed medical professionals, and medical practice owners. Health care businesses and even universities may be held liable for health care fraud.
Home Health Aide Service Health Care Fraud Schemes
Billing for Services and Procedures Not Provided
In this particular scheme, a home health aide submits bills to insurance companies for services or products that were never actually provided to patients, and may not have even been necessary.
- Owners of Home Health Care Agency Sentenced to Prison for Taking Part in $80 Million Medicaid Fraud.
In June 2016, Florence and Michael Bikundi, convicted of health care fraud, were a couple, who owned Global Health Care, Inc. – a home health care agency, used fraudulent funds gained through the business to fund a lavish lifestyle.
For about five years, the couple submitted fake claims to Medicaid, the government’s public insurance provider, for services that were not actually provided or not fully provided to their patients. Between 2009 and 2013, Global healthcare generated over $42.78 million in payouts.
Separately, they received seventeen years in prison, with three years of monitoring, after their release. Read more by clicking this link, or copying and pasting the URL below:
- Former Home Healthcare Nurse Sentenced for Medicaid Fraud in Case that resulted in Minor’s Death.
In July 2017, Mollie Parsons received 36 months (about three years) in prison for healthcare fraud concerning the death of a severely disabled minor. Prior to this incident, she had received ten years in prison for her role in the death of the minor patient.
Parsons frequently skipped her 8-hour shifts with the patient, while submitting claims to the contrary. As a result, she received pay for the services she did not provide, and the patient died. Parsons pleaded guilty to all charges against her.
For more information from the Department of Justice press release, click this link or copy and paste the URL below.
In this fraudulent scheme, a home health agency generally pays a third party – someone in the medical industry with access to patient records, to refer patients to them.
Medicare and Medicaid have a provision that blocks giving kickbacks for referrals.
- Baton Rouge Home Health Company Settles False Claims Act Case for $1.7 Million.
Charter Home Health, settled a false claims act case for $1.7 million in July 2017. The case stemmed from the business paying a third party for referrals of Medicaid and Medicare patients from 2006 to 2012. Paying for referrals violates Medicare’s anti-kickback provisions.
“‘Home health care providers paying for patient referral kickbacks will be held responsible at the settlement table. We shall crack down on illegal kickback arrangements undermining medical judgment, corroding public trust in health care, and diverting scarce Medicare funding.”
Read more about this case and statement made by Agent C.J. Porter, by clicking this link or copying and pasting the URL below:
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- Miami Home Health Care Agency Owner Indicted in $8 Million Medicare Fraud Scheme.
Orelvis Olivera, the owner of Miami-based home health care service Acclaim Home Health, was indicted on charges of health care fraud in September 2014. Olivera paid recruiters for referrals of Medicare and Medicaid patients to his business.
Said action violated the Medicare and Medicare anti-kickback provision, and as a result of these referrals, Olivera received over $7.3 million in fraudulent government funded payouts.
For more information from the Department of Justice press release, click this link or copy and paste the URL below.
Purchasing and Selling Patient Information
This scheme is part of patient referral kickbacks. The person who provides the patient information, in this scheme, steals the data and passes it on to home health care agencies to receive some form of payment.
- Owners of Two Houston Area Home Health Care Companies, Doctor, and Hospital Employee Sentenced for their Roles in $3 Million Medicare Fraud Scheme.
The hospital employee stole Medicare and Medicaid patient information and provided it to the health care company. The two owners of the home health company paid the hospital employee for his actions.
The health care company used these patient records to submit fraudulent claims to Medicare and as a result, received close to $3 million in payouts. All parties involved got time, and paid back the full amount fraudulently received as restitution.
For more information from the Department of Justice press release, click this link or copy and paste the URL below.
What Are The Possible Punishments for Health Care Fraud?
If convicted on charges of health care fraud severe penalties could include:
- Up to 10 years in prison.
- If, as a result of the fraud, someone suffers from death or serious bodily injury, up to 20 years in prison.
In addition, there are severe fines you may face for your role in a federal health care fraud scheme:
- Between $250,000 for an individual defendant and up $500,000 for a defendant organization.
- Possible double payback for whatever financial gain made as a result of the fraudulent scheme.
In addition to criminal penalties, one may also suffer through several civil penalties and fines, e.g. the loss of your medical license, and the inability to work as a home health aide, or medical professional again.
How Will a Health Care Fraud Case Proceed?
Enforcement of the Statute
Several government agencies are tasked with enforcing the federal health care law statute. The “heavy lifting,” so to speak, typically falls into the Department of Health and Human Services Office of Investigations (HHS-OI) since they oversee the Medicare and Medicaid programs.
This office has also set forth strict guidelines on what happens before a patient is approved to receive help from a home health aide and, even, how that home attendant must do their job to a certain extent.
The Federal Bureau of Investigation (FBI), the Medicare Strike Force, and the United States Department of Justice (DOJ) will also help in the investigations and enforcement of the statute.
Investigations into Potential Violations
Investigations into potential fraudulent conduct can begin in many ways.
- A patient not receiving proper treatment from their home health attendant but is gets a bill for the services may alert the appropriate authorities.
- A former, or current employee of the home health aide service in question may also alert the authorities if they think that fraudulent activity is occurring.
- An investigation resulting from questionable results of a Medicare billing audit or other typical investigation.
Note that if you become the subject of a health care fraud investigation, you should contact an attorney. During a search, comply with the warrant you are given but never answer questions or make statements without your counsel, who may save you from incriminating yourself.
Charges
The DOJ will file charges in the appropriate federal jurisdiction. The “jurisdiction” is the court hearing the case. This determination is made based on where the criminal activity took place but may also be found to be in the victim’s location or where the defendant lives.
For example, a home health service may register as a business in New York , but the fraudulent conduct took place in New Jersey – jurisdiction can operate in both locations.
It is imperative to enlist an experienced attorney as soon as possible. Having someone to protect your rights and interests at every level or a case, from investigation to sentencing – if it comes to that, will help to make sure you receive the best result possible.
What You Can Do
First and Foremost, contact an attorney. Whether you are under investigation or not, an attorney can provide individualized help to ensure that you never become the victim of fraud. They can also protect you from possible incriminating efforts, that you may or may not be aware of.
Our attorneys possess a wealth of knowledge in medical billing and coding, the different health care fraud schemes that commonly affect home health aide services, and the importance of the confidentiality of your patients.
It is your to take care of your patients when they are going through hard times. Allow our experienced attorneys to do the same for you.