Florida Home Healthcare Fraud Lawyer
Those who are suffering from serious medical conditions or old age are often forced to obtain home healthcare services who can provide assistance with bathing, eating, and administering medications. Medicare beneficiaries, however, are only eligible for these types of services if they are under the care of a physician who certifies that the beneficiary is home bound and requires physical therapy, occupational therapy, speech language therapy, or skilled nursing care.
While many healthcare providers are careful to recommend this treatment only when necessary, an alarming number of unscrupulous physicians certify that a patient requires home healthcare services even when they are not necessary and then bill Medicare or Medicaid for the service despite its not actually being provided. It is estimated that this type of fraudulent activity results in the loss of billions of dollars of federal funding every year, making it especially important for those with proof of this kind of fraud to step forward and file a whistleblower claim with the help of a Florida home healthcare fraud lawyer.
Who Qualifies for Home Healthcare Services?
Medicare beneficiaries who are confined to their homes due to illness, disability, or old age are eligible for certain medical services that can be provided in their homes, as long as the home healthcare services are:
- Deemed medically necessary;
- Properly documented; and
- Properly authorized by a physician.
Medicare is then billed based on the clinical severity, functional severity, and service utilization of the beneficiary’s condition. Typical services provided under this program include assistance with bathing and feeding, as well as help with medications. Unfortunately, some healthcare providers bill Medicare for home healthcare services even when they aren’t necessary or even provided, a form of fraud that is usually referred to as home healthcare fraud.
Examples of Home Healthcare Fraud
Home healthcare fraud varies in nature, but most often involves improper billing services, such as:
- Upcoding, or charging patients for more expensive treatment than they actually received;
- Submitting bills for patients who aren’t homebound;
- Scheduling visits by home health staff that aren’t medically necessary;
- Approving medically unnecessary home healthcare services in exchange for kickbacks;
- Asking beneficiaries to sign forms verifying a home healthcare visit that never occurred; and
- Forging a doctor’s signature or using false data or certifications to charge for home healthcare services.
These kinds of deceptive acts are strictly prohibited under both state and federal law, which means that healthcare providers who engage in this type of activity can be held accountable. In order to do so, however, a person is often required to step forward and notify the proper authorities that the fraud is ongoing. This is known as a whistleblower claim and requires that a claimant file a lawsuit under the False Claims Act in district court, where he or she could be entitled to a reward of between 15 and 30 percent of the amount recovered by the government.
Contact an Experienced Florida Home Healthcare Fraud Lawyer
To learn more about the process of filing a home healthcare fraud-related whistleblower claim, please call 561-659-7878 and schedule an initial consultation with one of the dedicated Florida home healthcare fraud lawyers at McCabe Rabin, P.A.