Friday, January 1, 2016

Four Home Healthcare Workers in Missouri Charged with Defrauding Medicaid - In Home Supportive Services Fraud

State programs pay home health care workers (IHSS in California) to take care of the non-medical needs of elderly and/or disabled patients who qualify for SSI. These services are performed at the patients' own homes since it is much less expensive than placing these patients in assisted living or nursing homes. 

This can be a great program. However, the concern about fraud threatens it. In addition, the individual providers are being targeted. These are not large companies but individuals who are often low paid workers. This article is to remind those providers to be careful and not to submit documents with false billing or entries on them regardless of the temptation. In California, it is considered Medi-Cal fraud.

Let's be clear. States are aggressively going after fraudulent billing in the home setting. California usually brings charges in state court but we can expect federal charges as well. Missouri just charged four individuals in federal court for billing for services not provided in November 2015, and they are expected to be sentenced in early 2016 following guilty pleas.

The government in these cases seeks to charge where there is ghost billing for services not provided. The Missouri federal charges show what kind of cases get charged. The first case filed recently include a home health care worker billing Medicaid when she was actually taking the bar examination in Jefferson City, Missouri, to become a lawyer. It is also alleged that this care worker was giving cash kickbacks to the patients of $100 to $200 per check. 

A second home health care worker billed Medicaid when his patient was actually in Florida. This worker also allegedly billed multiple patients and worked another job (nursing home) so that his total timesheets showed working more than 24 hours a day on a number of occasions. 

A third home care worker billed Medicaid the day after she was discharged from the hospital after giving birth to a newborn baby and was taking care of her newborn. Finally, a fourth home health care worker billed Medicaid for taking care of her husband which is against the rules but she hid the fact they were married. In addition, she billed for a day she was allegedly testifying at a disability hearing.

Submitting timesheets to the government with representations of hours worked can be the basis of a federal making false statements charge and/or a federal fraud charge. Each charge can result in sentences up to five years depending on the case. In home health care workers must be mindful that billing for services not provided is a crime. 

While the risk of getting caught may be low, if charges are brought there will be an exclusion from the government programs of Medicare and Medicaid (Medi-Cal in California). It can also adversely affect your future ability to secure employment if there is a fraud conviction.

This is a great program in many ways. Providers are often low income workers, friends or family members. The temptation to bill for services not provided due to the low pay given should be resisted. This is considered fraud like any other government billing program. When we received calls from those under investigation, we see the problems and hope to remind people to not get caught up in the assumption that false billing will not be prosecuted. 

Posted by Tracy Green, Esq.
Office: 213-233-2261


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