Home Health Aides Are No. 1 Medicaid Fraud Offenders

Home health care aides accounted for more criminal convictions in fiscal year 2014 than any other provider type investigated and prosecuted by Medicaid Fraud Control Units (MFCUs) throughout the United States.

Out of 1,318 criminal convictions in 2014, 30% involved home health care aides, according to the recently released annual report on MFCU activity from the Department of Health and Human Services Office of Inspector General (OIG).

MFCUs involve investigators, auditors and attorneys that investigate and prosecute Medicaid fraud and patient abuse. They existed in 49 states and the District of Columbia in 2014, and are jointly funded by the federal government and the states.

Most of the home health aide convictions last year were for fraud, particularly for falsely claiming to have provided certain services. For example, two Nebraska aides were convicted of a scheme in which they claimed to be simultaneously providing services for two clients located in two separate places, the report states.

There were about the same number of total convictions in 2014 as in 2013, according to the OIG report. The proportion that involved home health care aides increased slightly, from 26% in 2013.

Also in line with recent years, about three-quarters of MFCU convictions in 2014 were for fraud, while the remainder were for patient abuse and neglect.

In total, MFCUs recovered more than $12.5 million from 413 criminal fraud convictions of home health care aides in 2014. There also were 21 civil settlements or judgements involving home health care aides, netting about $547,000.

Home health care agencies were involved in 48 criminal fraud convictions, which resulted in recoveries of about $7 million. The 27 civil settlements or judgements involving agencies led to recoveries in excess of $186 million. Pharmaceutical manufacturers were the worst offenders in that category, with 463 settlements or judgements accounting for more than $1.2 billion in recoveries.

The government has long identified home health as a sector with a high prevalence of Medicare and Medicaid waste, fraud and abuse. For that reason, it has imposed a temporary moratorium on new home health agencies in certain locations, such as Chicago, Houston and Detroit.

Written by Tim Mullaney