An Increase in Federal Scrutiny of Medicaid Fraud in Home Care Could Lead to an Increase in False Arrests

On Behalf of | Mar 16, 2017 | Medicare and Medicaid Fraud

In a recent report released by the Department of Health and Human Services, home health care services have become a vehicle for fraudulent Medicaid claims. The report focused on the Personal Care Services Program, which provides care givers for the disabled and the elderly. These services can be billed to Medicaid and caregivers can range from trained professionals to family members.

The study found not only overbilling and overcharging of their elderly patients, but also found that severe neglect has resulted in numerous injuries to patients, as well. Some patients were left for days without any care, exacerbating illness and in a few cases leading to death from malnourishment.

Findings showed that some caregivers were reporting visits for people they may never even see and sometimes even filing under multiple aliases. Some companies were flagged when it was discovered that there were bills for more than 24 hours in one day for a caregiver, as well as reports of caregivers taking care of two patients in different locations at the same time.

Cases of neglect ranged from relative caregivers who never checked on their patients, to company services that forged time sheets and pay logs to receive funds without rendering services, to patient assistants who were committing the fraud to fulfill their opioid addiction. One caregiver was found to be splitting the payment checks with the wife of the patient, in return for being able to take the patients pain medication. The patient was then left to suffer while receiving no pain relief.

Regulations are Few and Far Between

There are typically no state regulations or oversight for the Personal Care Services and caregivers can often sign up without any experience or even a background check. In at least two of the fraud cases, the caregivers had previous convictions, one even for child neglect. To help prevent future fraud cases and prevent the risk of neglect, many states are proposing new regulations and changes to the Personal Care Service Programs.

Some of these requirements would include:

Background Checks

Many states have called for required background checks for any individual who applies to be a caregiver in an effort to reduce caregivers with criminal records from being able to claim payments for services.

Mandatory Training

A new requirement being looked into would include mandatory training for all caregivers and personal assistants, which they would be required to attend before being allowed to receive payment for care giving services.

Identification in Database

Advocates have called for the creation of a national, or state-wide database where each caregiver would be assigned an identification number, as well as be entered into a system once their identity has been verified.

Visit Accounting and Tracking

Some states have already implemented procedures requiring a personal assistant to call in before the visit as well as at the conclusion, so that the correct number of hours can be determined. This would also provide a tracking system of how many visits are made to each patient per week as well.

Risks of False Accusations Arising From Increased Oversight

While increased oversight by federal investigators can help to reduce the number of fraud cases and neglect of elderly and disabled, it also can lead to an increase in false accusations of fraud as well as false arrests. When large investigations turn up such horrifying cases as this one has, there can often me a misassumptions that most caregivers in this field are neglectful and out for money. This couldn’t be farther from the truth.

Being under such watchful scrutiny can result in false arrest of caregivers for legitimate claims that may be considered out of the norm. In addition, inexperienced care workers, such as relatives, may not understand the exact procedures of reporting time and may be charged with fraud over a simple miscalculation.

Caregivers and personal assistants could be at risk for fraud charges and flagged for investigation over simple issues because they are unaware of all the regulations. This will not only hinder the patient’s ability to choose a particular caregiver, but may also limit the amount of caregivers willing to take on the risk.

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