Home care fraud plagues government programs

The Office of Inspector General criticized the Centers for Medicare & Medicaid Services at a congressional hearing for failure to recoup inappropriate payments, and high on the list of contributors to those was the perennial issue of fraud-ridden home health services.

Testimony by Office of Evaluations and Inspections Acting Deputy Inspector General Brian Ritchie cited home healthcare as an area ripe for recoveries, according to a commentary by former U.S. Department of Health and Human Services Inspector General Richard P. Kusserow. Specifically, the OIG found nearly one-third of home health claims did not meet requirements for face-to-face encounters with patients. And OIG found billing trends resulting in hundreds of millions of dollars lost to fraud and abuse, Kusserow noted.

Case in point: The FBI announced a third wave of indictments this month charging 14 people in a sting known as "Operation Home Alone." Targeting Medicaid home care abuse in Illinois, the program takes its ironic name from the many times the state paid for ghost employees and fictitious services. The 43 people charged with fraud since 2012 include personal assistants and Medicaid beneficiaries.

Nationally, personal assistant programs are a significant Medicaid fraud risk, the announcement stated, especially when beneficiaries choose and pay their attendants. In most of these cases, the "personal care assistant" is a relative or friend who doesn't perform services but shares scam proceeds with the beneficiary, the FBI noted.

Perhaps the most embarrassing part of the Illinois fraud busts is that criminals kept filing false home care claims despite publicized indictments and prosecutions.

"Federal and state law enforcement in Illinois have spoken forcefully and with one voice against the abuse of a program vital to the health of Illinoisans," U.S. Attorney Stephen R. Wigginton said in the announcement, "but those who are abusing this needed program just don't seem to be listening. Ignore us at your peril."             

For more:
- read Kusserow's commentary
- here's the FBI announcement

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