Fight Fraud With A Dallas Home Health Care Lawyer
Individuals with knowledge of fraud committed by home health care agencies may be able to blow the whistle on this kind of fraud using the False Claims Act (FCA), the Texas Medicaid Fraud Prevention Act (TMFPA) and other whistleblower reward programs. Whistleblowers play a critical role in bringing this type of home health care fraud to light and holding wrongdoers accountable.
My name is James “Rusty” Tucker, and I am a whistleblower attorney. I have considerable experience and excellent results in home health care fraud cases. At the Law Offices of James R. Tucker, P.C., I handle these types of cases on a contingent fee basis, meaning you owe me no legal fees or expenses unless I obtain a recovery for you.
What To Know About Home Health Care And Federal Fraud
To receive Medicare benefits, patients of a home health care association (HHA) must be certified as homebound, meaning that leaving the home must involve a taxing effort under Medicare regulations.
These homebound patients of HHAs must be certified or recertified every 60 days, a period of time in Medicare regulations and HHA practice that is referred to as an episode.
To receive reimbursement by government-funded insurance programs (Medicare or Medicaid) for home health care services, providers must have documentation that they actually rendered the services and that the services were medically necessary. In addition, providers cannot claim payment from federal health care programs for home health care services resulting from an inappropriate referral from a health care provider, such as conduct that would violate the Stark Law.
Examples Of Home Health Care Fraud To Watch Out For
There are numerous opportunities for wrongdoers to take advantage of taxpayers to line their own pockets. Just a few common cases of home health care fraud that I regularly see include:
- Billing for services not provided: Charging for home health care services that were never actually delivered to the patient.
- Upcoding services: Billing for more expensive services than those that were actually provided, to receive higher reimbursements.
- Falsifying patient records: Altering or fabricating patient records to justify unnecessary services or to meet eligibility requirements for home health care.
- Kickbacks and referrals: Offering or receiving illegal payments or incentives for referring patients to specific home health care providers.
- Unnecessary services: Providing and billing for services that are not medically necessary for the patient’s condition.
- Misrepresenting provider credentials: Claiming that services were provided by licensed professionals when they were actually performed by unqualified staff.
- Duplicate billing: Submitting multiple claims for the same service to receive payment more than once.
- Patient identity theft: Using a patient’s personal information without consent to bill for services not rendered.
- Inflating hours worked: Reporting more hours of care than were actually provided to increase billing amounts.
- Noncompliance with care plans: Billing for services that do not align with the patient’s approved care plan.
These examples highlight the importance of vigilance and oversight in the home health care industry to prevent and detect fraudulent activities.
My History Of Holding Wrongdoers Accountable
One of my firm’s cases resulted in a judgment in 2019 of $339.4 million, making it one of the largest, if not the largest, home health care fraud cases in U.S. history. A large percentage of the patients of the HHAs receiving Medicare payments were not homebound, meaning that any claim submitted to Medicare for payment constituted a false claim under the FCA. The conduct of the defendants that owned the HHAs was so egregious that criminal charges were filed against four of the defendants. In another example, I recovered a $26 million whistleblower award for one of my clients. In that case, one of the nation’s largest providers of home health services agreed to pay $150 million to settle claims that some offices of the company billed Medicare for ineligible patients and services.
Discuss Your Options In A Free Consultation
If you are thinking of becoming a whistleblower, you do not have to take it on alone. I have considerable experience and have obtained excellent results in home health care fraud cases. For a free consultation please call 214-617-2181 or contact me online. I work on a contingency fee basis: You don’t pay unless I win.