Practice Areas

Home Health Fraud

Home health fraud involves billing Medicare for services that were never provided, certifying patients who do not qualify, or inflating the number of visits to increase reimbursement. If you work in a home health agency or a healthcare organization that oversees home health services and have witnessed any of these practices, you may have the basis for a qui tam case. Reach out for a confidential conversation. There is no obligation.

Practice Areas

Home Health Fraud

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WHAT IS MEDICAID FRAUD?

Medicare covers home health services for patients who are homebound and require skilled nursing care, physical therapy, occupational therapy, speech therapy, or home health aide services under a physician-certified plan of care. Home health fraud occurs when providers submit false claims to Medicare for these services, including claims for visits that never occurred, services provided to patients who do not meet the eligibility criteria, or services that were not medically necessary.

Because home health services are billed to Medicare, false claims in this area fall squarely within the scope of the False Claims Act. Healthcare insiders who have direct, first-hand knowledge of home health fraud may be eligible to file a qui tam lawsuit on behalf of the government and receive a share of any financial recovery.

In January 2026, Traditions Health LLC agreed to pay $34 million to resolve allegations that it submitted claims to Medicare for home health services that were not medically necessary and paid remuneration to physician-medical directors who referred Medicare beneficiaries to Traditions for home health services, potentially in violation of the Anti-Kickback Statute and the Stark Law.

Source: U.S. Department of Justice, January 23, 2026 | justice.gov

Legal basis: 31 U.S.C. § 3729 (False Claims Act) | 42 U.S.C. § 1396 et seq. (Medicaid) | Source: uscode.house.gov

TYPES OF HOME HEALTH FRAUD THIS PRACTICE HANDLES

Home health fraud takes several forms. The following are the most common types handled by this practice.

False Home Health Claims: Billing Medicare for home health visits that never occurred, or for a number of visits that exceeds what was actually provided. This includes billing for patients who were not at home on the date of the claimed visit, billing for visits made by staff who did not actually provide the services or were unqualified to provide the services, and submitting claims for visits documented only in falsified records.

Patient Eligibility Fraud: Medicare home health coverage requires that the patient be homebound and that a physician certify the need for skilled care under a plan of care. Patient eligibility fraud involves falsely certifying that a patient meets the homebound criteria or requires skilled services when they do not. Physicians, nurses, and billing staff who are aware of false eligibility certifications may have direct knowledge of a fraud scheme.

Visit Inflation: Visit inflation involves billing Medicare for a greater number of home health visits than were actually provided during an episode of care. This can include billing for supervisory visits that did not occur, inflating the frequency of aide visits in the plan of care beyond what was medically necessary and then billing for all of them regardless of whether they were provided, or documenting visits in electronic health records that did not take place.

Kickbacks to Referring Physicians: Home health agencies that pay remuneration to physicians in exchange for home health referrals violate the Anti-Kickback Statute and the Stark Law. These payments are frequently disguised as medical director fees, consulting agreements, or office space rental arrangements. Claims submitted to Medicare as a result of such referrals are false claims under the False Claims Act.

Legal basis: 42 U.S.C. § 1395f (Medicare home health benefit) | 42 U.S.C. § 1320a-7b (Anti-Kickback Statute) | 42 U.S.C. § 1395nn (Stark Law) | 31 U.S.C. § 3729(a)(1)(A) and § 3729(a)(1)(B) | Source: uscode.house.gov

WHO CAN REPORT HOME HEALTH FRAUD?

The strongest home health fraud qui tam cases come from current or former employees of home health agencies or healthcare organizations that oversee home health services, who have direct, first-hand knowledge of the fraudulent conduct. This includes home health aides and caregivers who know which visits were and were not made, nurses and clinical staff who are aware of patients who do not meet the homebound or skilled care criteria, billing specialists and coders who process claims they know to be inaccurate, office administrators with access to scheduling and billing records, and compliance officers who are aware of systemic billing practices that do not reflect actual services rendered.

You do not need all the documentation before contacting us. If you have witnessed conduct that you believe constitutes false billing to Medicare for home health services, that is enough to start a confidential conversation. We investigate thoroughly before asking for any commitment.

In fact, many former employees come forward with knowledge of fraudulent practices by their former employers after they have been demoted or terminated for complaining to their supervisors about the fraudulent practices or leaving their employment because they refuse to participate in the fraud.

Legal basis: 31 U.S.C. § 3730(b) (qui tam provisions) | Source: uscode.house.gov

YOUR PROTECTIONS AS A WHISTLEBLOWER

The False Claims Act prohibits your employer from firing, demoting, suspending, harassing, or otherwise retaliating against you for reporting fraud or participating in a qui tam case. These anti-retaliation protections apply to both current and former employees.

When you file a qui tam complaint, it is submitted under seal and served on the Department of Justice and any state agencies that have been impacted by the alleged fraud. Your employer is not notified and does not receive a copy of the complaint. Your identity remains protected throughout the government’s investigation.

If your employer retaliates against you, you have legal remedies that include reinstatement, two times the amount of back pay owed, interest on that back pay, and compensation for special damages including litigation costs and attorney fees.

Legal basis: 31 U.S.C. § 3730(h) (anti-retaliation) | 31 U.S.C. § 3730(b) (under seal filing) | Source: uscode.house.gov

WHISTLEBLOWER REWARDS

When a qui tam lawsuit results in a financial recovery, the False Claims Act entitles the relator to receive a percentage of the total amount recovered by the government. If the government intervenes and takes over the case, the relator may receive between 15% and 25% of the recovery. If the government declines to intervene and the relator proceeds independently, the share can rise to between 25% and 30%. There is no cap on the dollar amount of the reward. We work on a contingency fee basis. There is no upfront cost, and if there is no recovery, you owe us nothing.

Legal basis: 31 U.S.C. § 3730(d)(1) and § 3730(d)(2) | Source: uscode.house.gov

About This Practice

Arvind Bob Khurana has over 27 years of experience in qui tam and False Claims Act litigation, complex commercial litigation, and class action matters. He began his career at a top international defense firm and joined a national class action firm in 2005, becoming partner in 2009, where he worked on ERISA actions, qui tam cases, securities fraud, and antitrust matters. He is admitted to the New York State Bar and represents whistleblowers in federal courts nationwide.

We are selective. Before we ask for any commitment, we investigate the claim, explain the facts and the risks, and give you a complete picture of what you are facing. We never ask you to sign a retainer agreement until you have the full picture and have decided, on your own terms, that you want to move forward. You remain in control throughout.

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Arvind Bob Khurana has over 27 years of experience in complex litigation. We work on contingency. There is no upfront cost and no obligation to proceed.