Recent action against home health and personal care aides make it clear that aides risk criminal prosecution when they commit fraud. Here are some examples:
- A personal care aide pled guilty to health care fraud on the basis that she caused the Medicaid Program to issue payments totaling $399,000 for services she did not render. The aide paid kickbacks to beneficiaries and submitted false time sheets to home health agencies for which she worked. She also submitted false time sheets claiming that she provided personal care aide services while she was out of the country. The aide faces eighteen to twenty-four months in prison and a fine of up to $250,000. The aide must also pay $316,887 in restitution and $316,887 in a forfeiture money judgement.
- A personal care aide pled guilty to health care fraud on the basis that she paid illegal cash kickbacks to Medicaid beneficiaries in exchange for signing false time sheets. The aide faces up to ten years in prison and a fine of up to $40,000. The aide must also pay $441,234 in restitution and at least $257,503 in a forfeiture money judgment.
- A home health aide at a Medicare-certified home health agency was found guilty of participation in a $7 million fraud scheme. According to evidence presented at trial, the aide conspired with the owners of the agency and others to submit claims to Medicare for unnecessary home health services for unqualified patients or for visits that were not actually performed, but were billed to the Medicare Program. The aide faces time in prison and significant fines.
- A personal care aide was sentenced to thirteen months in prison for health care fraud. The aide was also ordered to pay $534,073 in restitution and $302,414 in a forfeiture money judgment. The aide paid kickbacks to beneficiaries and submitted false time sheets to home health agencies claiming that she provided twenty-four hours or more of personal care aide services during twenty-four-hour periods of time. She also submitted time sheets claiming that she provided personal care aide services while she was out of the country and while patients were hospitalized.
Engaging in fraud doesn’t just affect owners and managers of private duty, Medicare-certified home health agencies, and hospices. Prohibitions against fraud don’t just affect Medicare certified home health agencies and hospices; private duty agencies must comply, too! Both home health and personal care aides must understand what is at stake when they submit time sheets that do not accurately reflect the time they actually spent caring for patients. As the above cases illustrate, aides risk jail time and large payments in restitution and fines.
If necessary, give aides at your agency or hospice copies of this article to help them understand just how high the stakes are for them. It now seems urgent to bring home this point in order to stem the tide of fraudulent conduct.
©2020 Elizabeth E. Hogue, Esq. All rights reserved.