What day is National Report Home Healthcare Fraud Day celebrated? November 6
What is National Report Home Healthcare Fraud Day? National Report Home Healthcare Fraud Day not only brings awareness to the amount of Medicare fraud but provides the public with detailed steps for reporting home healthcare fraud. Medicare fraud affects us all. Ten percent of all Medicare funds are lost due to fraud. Because the government spends $650 billion a year on Medicare, $65 billion a year is lost to Medicare fraud alone. It’s no wonder why we have a national healthcare crisis! It’s time the public stands up and puts an end to home healthcare fraud.
Who created this day? National Report Home Healthcare Fraud Day started in 2017. It was formed by The Hesch Firm, LLC after founding attorney, Joel D. Hesch, left government practice to help whistleblowers file for rewards. Mr. Hesch had devoted over 15 years working in Department of Justice whistleblower reward office where he helped obtain $1.5 billion in recoveries back for the government from those cheating Medicare. In the process, Mr. Hesch helped the government pay out hundreds of millions in rewards to whistleblowers. Mr. Hesch formed his own law firm and now exclusively represents whistleblowers nationwide in filing for rewards for reporting fraud against the government, including home healthcare fraud. Mr. Hesch has helped other whistleblowers obtain significant rewards for reporting home healthcare fraud. To help whistleblowers properly report Medicare fraud, he authored a free e-book on reporting Medicare fraud, and created a website to ensure that the public knows how to properly report Medicare fraud and follow the steps necessary to be eligible for a reward. Visit the website: www.HowToReportFraud.com.
How to celebrate: Celebrate National Report Home Healthcare Fraud Day by visiting Mr. Hesch’s website or by downloading his free e-book so that you understand the various Medicare fraud schemes and the Department of Justice whistleblower reward program. The website and book explains the benefits and risks of reporting fraud and the various ways you can report Medicare fraud. If you have the right type of information, you can and should report Medicare fraud.
How to report Medicare Fraud and received a monetary reward: There are two very different ways of reporting Medicare fraud, with two very different results. One is to report home healthcare fraud under the Department of Justice (DOJ) reward program, which pays whistleblower rewards of up to 25% of the amount DOJ recovers. The average DOJ reward for reporting Medicare fraud is $690,000 and some rewards have been as high as $150 million! In addition, if you Medicare report fraud under the DOJ program, the government must open an investigation and inform you of the results. Thus, applying for a reward is the only way to ensure an investigation takes place (rather than just calling a hotline). Today, over three-fourths of the government’s Medicare fraud cases are DOJ whistleblower reward cases. Thus, the government is counting on whistleblowers to report home healthcare fraud to DOJ and receive a reward in the process.
The other way to report Medicare fraud is to report fraud directly to the Centers for Medicare & Medicaid Services (CMS), which runs the Medicare program. The downside by reporting the fraud to CMS is that the reward is limited to $1,000 rather than the DOJ program that pays up to 25% with no limit or cap. You can report fraud directly to CMS through its website or by calling its hotline.
Here is a link to the CMS website: https://oig.hhs.gov/fraud/report-fraud/index.asp.
Here the CMS hotline: 1-800-MEDICARE (1-800-633-4227).
Overview of Home Health Care Fraud Schemes:
Medicare Home Health Care reimbursement requires “homebound” status. Medicare pays benefits to those who are homebound, which means that they are generally confined to their homes, including certain medical services provided at home. This means that a person is confined to the home except for infrequent or short absences or trips for medical care.
In addition, not all home health care services are covered by Medicare. To be reimbursable by Medicare, the home health care provider must also show that the Medicare recipient or beneficiary is in need of one of the following medical services: skilled nursing, physical therapy, continuing occupational therapy, or speech language pathology.
Home health care “Plan of Care” fraud
The amount of payment to a Home Health Agency (HHA) depends upon what home health resource group (HHRG) the Medicare patient is classified. The HHRG group assignment is based upon things such as the diagnosis and the functional capacity and service use. Basically, more is paid for patients with more severe medical conditions because that requires more home visits and more home provided Medical services.
To be covered by Medicare, any home health service must be provided under a “plan of care,” established by a doctor. If the doctor or physician does not determine that the Medicare patient is homebound and also review and sign a plan of care, it is likely Medicare home health care fraud. The plan of care is also important because Medicare only covers home health care services that are established to be medically necessary, properly documented, and authorized by a physician. If the home health care goes beyond 60 days, there must be a re-certification by the physician.
Some home health care providers cheat Medicare by providing home health care services when the patient is not home bound. The elderly are often pawn in this fraud, because the home health care providers offer to do the medical services at home. It is not wrong or the fault of the Medicare beneficiary to accept offers to receive medical services at home, but the home health care provider knows that they cannot bill for the home provided services.
Home health care kickback fraud and assisted living facility fraud (ALF fraud)
Two common fraud schemes by home health care companies are (1) paying a doctor a kickback, either financially or through other benefits, to certify the Medicare patient as homebound, or (2) forging the physician’s signature or otherwise using false data or certifications.
The forms of kickbacks are often disguised, such as trips or speaking fees. In addition, a form of a kickback or Stark violation is when the home health care company has an ownership interest in assisted living facility (ALF) and the home health care company provides home health care services at the assisted living facility (ALF). It is Medicare fraud for a home health care company or provider to have an assisted living facility (ALF) self-refer Medicare patients to a related entity.
There are many other forms of Medicare fraud associated with assisted living facility (ALF) in connection with home health care services.
Fraudulent billing for home health care services not provided or rendered
Another form of home health care fraud is billing for services not provided. Some home health care providers bill for making 3 visits a week but only go to the Medicare recipient’s home 2 times a week. Other home health care fraud schemes include billing for services that they do not perform. They may provide one service, but claim to provide three services.
Free E-Book for reporting Medicare fraud. To help whistleblowers properly report home healthcare fraud (or any Medicare fraud), Mr. Hesch authored a free e-book on obtaining rewards for reporting fraud against the government. You can also go directly to Mr. Hesch’s website to start the process of filing for a whistleblower reward (www.HowToReportFraud.com).