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Avoiding Criminal Charges Home Health Care Fraud Investigations Lawyers

June 30, 2020

Health care fraud is sadly a commonplace occurrence here in the United States. Government watchdog agencies are charged with finding and prosecuting criminal charges against any healthcare provider that is suspected of Medicaid, Medicare and many other related health care frauds especially in the growing home health care industry.

The laws that govern health care fraud investigations are complex and difficult to interpret even for legal experts at times. It is crucial to consult with actual home health care fraud investigations lawyers if you have been charged with any type of home health care fraud.

Who Can Be Charged with Home Health Care Fraud?

Any person that is licensed to practice nursing or medical care can be charged with health care fraud if they are caught documenting false information related to the care of an individual receiving some type of government or other health insurance healthcare benefits. Many certified nursing assistants also work in private or group home care settings. These health care providers also are responsible for documenting accurate patient care details.

Typically, these charges are lodged against the primary care provider. This can include family members caring for an elderly or ill family member at home, nurses employed through a home care agency and owners and/or top administrators of home care type agencies and companies.

Being Charged with Home Health Care Fraud Can Ruin Careers

Even the hint of suspicion regarding home health care fraud can ruin the careers of the accused. If convicted, a licensed doctor, nurse or other healthcare licensed providers can lose their licences that are necessary to practice their professional craft. Health care facilities, home care agencies and other home care settings can also lose their licensing and certifications that allows them to operate in their local community.

During a home health care fraud investigation, these health care providers may be stopped from taking in new patients. If a criminal charge of home health care fraud sticks, the convicted provider will face steep fines, a possible felony criminal conviction on their record and possibly serious jail time or long probationary periods as well.

Understanding the Legal Definition of Home Health Care Fraud

According the the legal definition of home health care fraud, this term refers to a white collar crime when a home care provider misrepresents care related data or conceals care information in order to illegally receive benefits or make some type of profit. These criminal fraud charges can be tried in state or federal courts depending on the actual charges involved.

Some Examples of Home Health Care Fraud Scenarios

The most common form of home health care fraud that occurs is when a health care provider bills Medicare, Medicaid or other insurance entities for services that the patient never received. Another example of health care fraud is termed upcoding, and this is when a provider bills for a procedure or care expense at a higher cost than the actual procedure or care expense really costs.

Other health care fraud examples include:

  • Submitting duplicate claims when only one was provided
  • Kickback type situations involving Medicaid or Medicare
  • Falsifying dates of service
  • Unlawful administration or dispensing of medications
  • Billing for prescription medications that were not given
  • Over prescribing medications
  • Billing for individual steps of a procedure rather than just the whole procedure cost to increase payments received – unbundling
  • Misrepresentation of who provided a particular treatment or procedure – a nurse or PA instead of a medical doctor etc.
  • Billing for services that were not medically needed
  • Billing insurances for ghost patients – dead or otherwise fake patient documentation

Possible Legal Consequences of Home Health Care Fraud Cases

Along with being charged with healthcare fraud, Medicaid/Medicare falsification or documents and/or kickback scheme charges, the health care providers can also be charged with additional related criminal charges. These include forgery, theft of government services, conspiracy, making false statements, money laundering and others.

To avoid criminal charges related to home health care fraud, contact an experienced home health care fraud defense attorney.



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