The ability to have a medical professional come into one’s home and provide care to those who are suffering from diseases like Parkinson’s, Alzheimer’s and others is growing in popularity. This relationship, like any other that results in billing Medicare and other insurance providers, can result in allegations of health care fraud. There are many myths that abound around health care fraud and the home health care system, but three of the more common include:
- Officials will not respond to allegations of home health care fraud. Although the rules and regulations surrounding this area are complicated and loopholes are present, that does not mean the police will fail to respond to allegations of health care fraud. The Department of Justice (DOJ) along with police will investigate and enforce the laws, including moving forward with criminal charges where the evidence supports the presence of a violation.
- Health care fraud is hard to find. Health insurance providers, including Medicare, have software and other tools to help monitor payments and check for fabricated claims.
- Officials do not consider health care fraud a serious crime. Although a white-collar crime that does not result in direct violence to individuals within the community, it is important to note officials still consider health care fraud a serious crime. In addition to criminal charges, allegations of health care fraud can also result in loss of one’s professional license and the ability to continue a profession within the health care field.
One concession from the government to home health care agencies: they recognize home healthcare fraud is not an easy crime to commit. It generally requires an elaborate relationship with doctors and other medical professionals. As a result, the DOJ is likely to review any relationships between home health care agencies and other medical professionals, like physicians. They will look closely over the relationship, looking for an illegal agreement to provide compensation to physicians in exchange for using the home health care facilities. If such a relationship exists, the DOJ will likely pursue criminal charges for Anti-Kickback Statute violations.
Those who are under such an investigation are wise to act to protect their interests.