One of the top ten risks highlighted by the Texas Association for Home Care and Hospice and Liles Parker PLLC is fraud in government-funded healthcare programs that lead to criminal liability.

The Office of Investigations conducts criminal, civil and administrative investigations of fraud and misconduct related to U.S. Department of Health and Human Services programs, operations and beneficiaries. State-of-the-art tools and technology assist investigators for the Office of the Inspector General around the country and help the investigations office meet its goal of becoming the world’s premier health care law enforcement agency.

Several criminal liabilities levied against home health agencies in recent years were a result of the inspector general  office’s investigative and legal work as part of its Most Wanted Health Care Fugitives initiative, the Medicare Fraud Strike Force, the Health Care Fraud Prevention and Enforcement Action Team, and other similar efforts.  A few examples:

• A federal jury in the Southern District of Texas convicted a Houston-based home-health agency owner for her role in a $13 million Medicare fraud scheme and money laundering.

• The owner of several Detroit home health care companies was sentenced to 30 years in prison for his role in a Medicare fraud scheme that caused approximately $33 million in losses.
• The owner of a Tampa, Florida, home health agency was convicted by a federal jury for her participation in a multimillion-dollar health care fraud and money laundering scheme.
• The owner of a home health care company headquartered in Lemont, Illinois, admitted in federal court that he paid illegal kickbacks to procure referrals of elderly patients on Medicare.

A revised Medicare Fraud & Abuse: Prevention, Detection, and Reporting booklet is available. Learn more about fraud and abuse definitions, laws used to fight fraud and abuse, and government partnerships engaged in fighting fraud and abuse. Protect yourself by understanding the process thoroughly.