Mobsters see home health care as a happy hunting ground for ill-gotten gains.
The fact that federal fraud fighters recover $4 billion a year in false claims sounds pretty impressive — until you consider that Medicare & Medicaid fraudsters rake…
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February 2nd, 2010 at 11:16 am
Unfortunately, to me, this story is a little fuzzy on the details of how the fraud is perpetrated. So is the linked NPR story. All Medicare certified home health agencies must pass rigorous, on-site inspections before they get their provider numbers and routinely afterwards to maintain their Medicare / Medicaid provider numbers. Part of the inspection consists of the inspector showing up with a list of the agencies patients already in hand and asking to go to the patients’ homes, visit with the patients, and see the nurses in action. There is little room for fraud with these types of inspections. I am guessing that the crime story above is saying that this fraud is a type of identity theft in which criminals steal the provider numbers of real home health agencies. But even then, Medicare and Medicaid pay by electronic transfer into a designated bank account.
February 8th, 2010 at 8:21 pm
Hi Gary: Thanks for writing in. I didn’t deal too much with details in this one, because I’ve written about this topic before in recent months.
For a closer look at how some of these home health fraud schemes work, see this recent Miami Herald article from late last year: http://www.homecarelawblog.com/my-blog/2009/10/health-care-fraud-and-organized-crime.html.
For another perspective, see this post by home care attorney Robert Markette, which explains how determined criminals manage to evade a lot of the safeguards the feds put in place: http://www.homecarelawblog.com/my-blog/2009/10/health-care-fraud-and-organized-crime.html.
March 2nd, 2010 at 1:58 pm
Thanks for the response and additional info!