Last month, the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) published Medicare Advantage Industry Segment-Specific Compliance Program Guidance (“Guidance”). OIG described the Guidance as “OIG’s updated and centralized source of voluntary compliance program guidance for Medicare Advantage.”[1] The impetus for creating the Guidance was “the growing popularity” and OIG’s
Renewed Federal Focus On Abuses in Home Health Industry
Last month, Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (CMS), accompanied by other CMS officials, visited with home health and hospice providers and related industry associations to discuss ways to strengthen program integrity enforcement. CMS was reacting to calls from industry stakeholders and members of Congress to get a handle
OIG Gives Thumbs Down to Payment of Sign-On Bonuses by Home Care Agency
In an unfavorable Advisory Opinion issued last week[1], the Office of Inspector General, U.S. Department of Health and Human Services (OIG) found that a home care agency’s plan to market sign-on bonuses to prospective employees with the intention of employing those individuals to provide services to family members could result in sanctions for
Electronic Visit Verification: The New Frontier in Home Health Fraud Enforcement
The 21st Century Cures Act (Cures Act) required states to adopt electronic visit verification (EVV) systems for Medicaid-covered personal care services (PCS) by January 1, 2020 and for home health care services (HHCS) by January 1, 2023. According to the Centers for Medicare and Medicaid Services (CMS), the EVV requirement was imposed “in response to
Home Health Care Continued to Be a Federal Enforcement Target in 2025
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
The Intersection Between OMIG’s Home Care Audit Protocols and Liability Risk Under The False Claims Act
The New York Office of the Medicaid Inspector General (OMIG) publishes audit protocols to “assist the Medicaid provider community in developing programs to evaluate compliance with Medicaid requirements under federal and state statutory and regulatory law.”1 Such protocols are “applied to a specific provider type or category of service in the course of an
A History of CDPAP Enforcement at the NYS AG’s Office
New York’s Consumer Directed Personal Assistance Program (CDPAP) has long been the subject of enforcement at the New York State Attorney General’s Office (AG). Many of those enforcement actions involve caregivers who billed Medicaid for CDPAP services never provided but sometimes also implicate agencies that are responsible for processing caregiver payments and protecting against fraud.
The Feds Have Home Care Kickback Arrangements in Their Crosshairs
The federal government has demonstrated that it is more than willing to use the United States criminal code to prosecute home care agencies that pay unlawful financial inducements to generate referrals in violation of the Anti-Kickback Statute (AKS).
In a superseding indictment unsealed in March 2025, the United States Attorney’s Office for the Eastern District
DOJ and HHS Announce FCA Working Group
On July 2, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced the formation of the DOJ-HHS False Claims Act Working Group to strengthen “their ongoing collaboration to advance priority enforcement areas” in combating healthcare fraud. The two agencies cited the long history of partnership between them in enforcing
The Latest Refinements to DOJ’s White Collar Enforcement Policy
Last month, the head of the Criminal Division of the U.S. Department of Justice (DOJ), Matthew R. Galeotti, issued a Memorandum outlining DOJ’s enforcement priorities and policies for prosecuting white-collar crime, identifying three core tenets to guide prosecutors: “(1) focus; (2) fairness; and (3) efficiency.”
Among the areas of focus listed, the Memorandum identified as