The United States Department of Justice (DOJ) Fraud Division, U.S. Attorney’s Office and Pennsylvania Attorney General have charged 19 defendants for a $4 million fraudulent Medicare and Medicaid scheme involving home care. The schemes involved submitting claims for home health services that never occurred or billing an exorbitant number of hours within an unrealistic period, the DOJ alleged.
One of the purported schemes involved a home health aide purportedly serving seven clients simultaneously, providing over 1,100 instances of billing more hours than are within a day. This scheme allegedly resulted in over 64,000 impossible hours and more than $1.2 million in Medicaid payments.
In another instance, the two operators of a home care agency allegedly used false timecards to fuel $224,000 in fraudulent Medicaid payments.
Other examples include one aide allegedly billing over 8,700 overlapping hours, including than 400 instances of delivering over 24+ hours of care in a single day. Another defendant allegedly worked as a carpenter while claiming to need extensive care, generating over $160,000 in claims. Another defendant billed over $600,000 for Medicaid-based care while traveling, most of which was fraudulent, according to the release.
“Home care funding exists to assist America’s elderly and most vulnerable — not to fund schemes in which aides claim be providing care while incarcerated or vacationing in Miami and Saudi Arabia,” Assistant Attorney General Colin M. McDonald of the DOJ’s National Fraud Enforcement Division said in a statement.
The charges of these Medicaid- and Medicare-related instances of fraud are part of the DOJ’s Health Care Strike Force, which prosecuted over 6,200 defendants who billed federal health care programs and private insurers more than $45 billion cumulatively.
These crack downs come amid the Centers for Medicare & Medicaid Services (CMS)’ attempts to mitigate illicit financial activity within the home-based care industry. In that pursuit, CMS enacted six-month moratoria on new Medicare provider enrollments for new home health agencies and hospices to cut down on waste, fraud and abuse that went into effect on May 13.
“CMS will continue partnering with law enforcement to shut down these scams while establishing new anti-fraud safeguards that flag criminal activity before the money ever leaves the building,” CMS Administrator Dr. Mehmet Oz said in a statement. “This Administration is taking a whole-of-government approach to protecting Medicaid — ensuring the program serves the Americans who depend on it, not criminals seeking to exploit it.”