Physicians who order home health where it is not medically necessary can be charged with Medicare fraud. If that same physician orders medications, especially controlled substances, without seeing the patient on a regular basis, that can be another ground for a fraud charge.
The loss amounts can be huge since the physician will be held responsible for the total amount of billings by the home health agency and the pharmacy's prescriptions. A recent case illustrates a physician who ordered home health in exchange for payments and then also prescribed some pain medications that were medically unnecessary.
On January 6, 2020, Kain Kumar, a former doctor, was sentenced to 24 months in federal
prison after having pleaded guilty in April 2019 to one count of health care fraud and one count of distribution of hydrocodone. Mr. Kumar practiced internal medicine, maintained medical offices in Palmdale, Rosamond, and Ridgecrest, California and surrendered his medical license last year.
He was sentenced by U.S. District Judge Philip
S. Gutierrez. Mr. Kumar was also ordered to pay financial penalties totaling more
than $1 million, consisting of $509,365 in restitution, $494,900 in asset
forfeiture, and a $72,000 fine.
