Federal Bill Would Expand Crackdown on Medicaid Home Health Fraud

Democratic Rep. Peter Welch of Vermont on Tuesday unveiled bipartisan legislation to combat Medicaid fraud and abuse originating outside of institutional health care settings. The bill would build on the authority of state Medicaid Fraud Control Units (MFCUs) and expand the scope to encompass all Medicaid services including non-institutional settings, such as home health care. […]

Why the Looming AseraCare Decision Could Decimate Hospice Fraud Prosecution

Trends in hospice fraud have authorities on high alert and providers feeling the heat. But a looming, potentially precedent-setting legal case currently in the hands of the 11th Circuit Court of Appeals may soon make the prosecution of hospice providers much more difficult to pursue under the False Claims Act (FCA). “[The case] could decimate […]

OIG Puts the Pressure On as Hospice Fraud Cases Pile Up

In March 2018, Health and Palliative Services of the Treasure Coast and two of its businesses paid $2.5 million to settle a False Claims Act (FCA) case related to hospice billing. A month later, Horizons Hospice agreed to pay more than $1.2 million to resolve allegations that the company fraudulently billed Medicare and Medicaid for services to patients […]

Home Health Agency Wins Payment Fight With CMS in ZPIC Audit

A home health agency will be paid for services following a court win that prevents the Centers for Medicare & Medicaid Services (CMS) from withholding and recouping payments—at least temporarily. A judge granted the home health agency’s temporary restraining order motion in the case, Family Rehab., Inc. v. Azar, which will temporarily ensure payments are not […]

Fraud Watch: Michigan Agency Owner Guilty in $8 Million Fraud Case

Michigan Agency Owner Pleads Guilty in $8 Million Fraud Scheme Zahir Shah, 48, of West Bloomfield, Michigan, pleaded guilty to fraud charges for his role in a scheme involving approximately $8 million in fraudulent Medicare claims for home health services procured through illegal kickbacks, according to the Department of Justice (DOJ). Shah pleaded guilty to […]

Top Payment Scrutiny Areas in Hospice Care

As more government agencies leverage data analysis and tracking to monitor billing in the home health and hospice space, providers are seeing heightened scrutiny across billing practices. From time to time, everyday mistakes in documentation and challenges with compliance can lead to bigger problems—even when providers think they are doing everything right. In 2015, hospice […]

Fraud Watch: Miami Home Health Owners Indicted in Scheme

Three Miami Home Health Agency Owners Charged in Fraud Scheme Three Miami-area home health care agency owners were charged in an indictment for their alleged participation in a health care fraud scheme involving a now-defunct business, the Department of Justice (DOJ) announced in March. Ailin Consuelo Rodriguez Sigler, 39; Ziola C. Rios, 57; and Thomas […]

U.K. Home Care Startup Accused of Posting Fake Reviews Online

Since launching in 2016, U.K. home care startup Cera Care, which pairs patients with in-home caregivers, has locked in more than $4 million in venture funding and garnered widespread praise. But now, it’s being accused of crafting fake reviews online and lying about key health partnerships, Bloomberg Technology reported Thursday. Citing “three people with knowledge of […]

Texas Home Health Care Owners Make OIG’s Most Wanted List

The Office of Inspector General (OIG) has named a former owner of a Texas-based home health care company, Ebong Aloysius Tilong, among its “most wanted fugitives.” Tilong was indicted on charges of conspiracy to commit health care fraud, health care fraud, conspiracy to pay kickbacks, payment of kickbacks and conspiracy to commit money laundering in […]