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Medicare fraud in the home health care sector

On Behalf of | Jul 28, 2023 | Health Care Crimes |

Home health agencies perform medical and nursing services in a patient’s residence, and the market sector they occupy has experienced rapid growth in recent years. Home health spending more than doubled between 2002 and 2009, but most of that spending was concentrated in a few areas. Unusual spending patterns are often a sign of fraud, so the Department of Justice set up anti-fraud offices to investigate home health spending in these areas. The first of these offices was opened in Florida in 2017.

Health care fraud

The DOJ has also opened anti-fraud offices in California, New York, Louisiana, Michigan, Illinois and Texas. The increase in home health care billing per Medicare patient in parts of the country where the DOJ did not open health care fraud offices averaged $289 between 2002 and 2009, in parts of Florida and Texas, the average increases exceeded $2,000. Common types of home health care fraud include submitting bills for unnecessary services or services that were not provided, offering kickbacks to physicians who refer patients and sharing patient information with other HHAs.

HHA fraud study

A team of researchers from the Geisel School of Medicine at Dartmouth recently used a new networking analysis approach to study Medicare claims data. When they looked at claims submitted by HHAs in the areas targeted by the DOJ, the researchers noticed that unconnected agencies engaged in the same kind of fraud. This led the researchers to conclude that HHAs in these areas worked together and shared information. The results of the study were published in the medical journal Social Science & Medicine.

Analytical tools

Medicare fraud in the home health care sector is highly concentrated in areas known for lax oversight. The results of a recent study suggest that HHAs in these areas work together to flout the law. The researchers who conducted the study used novel analytical tools to identify billing discrepancies, and they believe that similar approaches could be used to prevent fraud in the future.