How To Avoid Home Care Billing Fraud

Most home health care agencies are honest in their service and billing procedures, but fraud, particularly with Medicare /Medicaid is a growing problem. Knowing what services you are or are not to receive can help you identify possible fraud. The following information will be useful:

• Request a copy of your Plan of Care. It will include specific information about the services you are to receive and when you are to receive them. It will include skilled care by a nurse, social worker or rehabilitation therapist, home health care workers, durable medical equipment, and medical supplies.
• Be aware of any changes in service that do not match those in your Plan of Care. You should be informed if there are to be changes. Any changes should only be made by a doctor who is actively involved in your care. If you are uncertain about a new service, call your doctor to confirm that she authorized the change.
• Pressure to accept items and services that you do not believe you need should send up a red flag.
• Keep track of home health visits that your doctor orders but are not received.
• Do you receive visits from home health staff that are not scheduled or needed? If a visit is made by anyone other than a volunteer, there will likely be a charge for the service.
• Review bills and payment forms for services and equipment you never receive. Medicare/Medicaid and some insurers routinely provide you a copy of services for which they have paid. If you suspect fraud, ask for a copy of bills or records of payment.
• Medicare/Medicaid cautions their recipients to beware of any home health agency or individual that offers free goods or services in exchange for your Medicare number, even if only needed "for their records." Your Medicare card should be treated like a credit card or cash.
• If you suspect fraud notify your state home health agency or report it to your insurer.

We know of a gentleman receiving home care, who continued to receive medical supplies that he did not need or want. When calling the provider to complain, he was informed that the items could not be returned after he had received the boxes and opened them in his home. To work around the problem he began to open the boxes outside of his home while the delivery person waited. If he did not want the delivered item he simply taped the box up and handed it back, refusing the delivery.

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