The 2025 National Health Care Fraud Takedown, announced in June, was the largest in history, with 325 defendants charged (including 96 providers) in 50 federal districts. In all, the charged schemes involved more than $14 billion in intended loss, and more than $245 million in cash, luxury vehicles, cryptocurrency and other assets were seized. These enforcement actions involved both federal and state law enforcement agencies from across the country. And home healthcare was prominently featured among the various schemes charged.
- Two providers from Michigan were indicted on healthcare fraud charges as part of schemes to accept Medicare referrals from home health agencies. Hundreds of thousands of dollars were paid by Medicare for services allegedly rendered. In return for these referrals, the defendants were alleged to have falsely certified the patients as homebound, which allowed the home health agencies to bill Medicare for medically unnecessary services.
- A licensed home health aide from Indiana submitted claims to Medicaid claiming to have provided in-home services for a Fort Wayne, Indiana patient on dates when she actually was vacationing in Myrtle Beach, South Carolina.
- A licensed practical nurse from New York was charged with grand larceny, offering a false instrument for filing, and falsifying business records in connection with a scheme to defraud Medicaid by submitting claims for home health hours worked that far exceeded services actually rendered. The defendant also was accused of illegally sharing her Medicaid reimbursement with a patient with whom she colluded.
- A home health aide from Ohio was charged with Medicaid fraud and theft for submitting, while employed by a home health agency, time sheets falsely claiming that he provided in-home services while the recipient was hospitalized for three months.
Home healthcare continued to be on DOJ’s enforcement radar the rest of the year.
For example, in August, DOJ announced that the New York owner of two social adult day cares and a home health care fiscal intermediary pleaded guilty to defrauding Medicaid. The owner conspired with marketers to pay kickbacks and bribes to Medicaid recipients to induce referrals to the owner’s day cares, which billed Medicaid for services that were either not provided or were fraudulently induced. The fraudulent proceeds were laundered through various business entities and used to pay the kickbacks and bribes. In announcing the guilty plea, the HHS-OIG Deputy Inspector General for Investigations declared that “Social adult day care and home health services are intended to support seniors, not serve as vehicles for fraud.”
And just last month, the owners of a Pennsylvania home care agency and two of their employees were charged with healthcare fraud in connection with a scheme to defraud Medicaid by billing for home health services that were not rendered. The defendants are alleged to have completed electronic visit verification calls attesting that home care services were provided when nobody from the agency was present with the client who allegedly needed the services.
These examples are evidence of the continued focus of federal law enforcement on home healthcare fraud schemes. Now is the time to examine your compliance protocols and ensure that your business operations do not become the next target for federal scrutiny.
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