Home Health

Earlier this month, an owner of Brooklyn-based Happy Family Social Adult Day Care Center, Inc., Family Social Adult Day Care Center, Inc. and Responsible Care Staffing, Inc., a home health care fiscal intermediary operating under the Consumer Directed Personal Assistance Program (CDPAP), pleaded guilty to defrauding Medicaid of approximately $65 million for social adult day…

In August, Assistant Attorney General Colin McDonald issued a memorandum (the “Memo”) announcing the enforcement priorities of the National Fraud Enforcement Division (also known as NFED), which the U.S. Justice Department (DOJ) established in April of this year.[1]   

McDonald noted that NFED “has quickly established a nationwide footprint” since launching in April and…

With the New York Medicaid Program facing scrutiny by the U.S. Department of Health and Human Services (HHS) for a perceived lack of oversight and compliance integrity involving certain types of providers (including personal care and home health providers), the New York Department of Health (DOH) recently announced certain program administrative measures that seem designed…

On July 1, 2026, the Centers for Medicare & Medicaid Services (CMS) proposed a new rule that included certain enrollment-related policy changes under the Home Health Prospective Payment System (HHPPS) designed to “reduce improper Medicare payments and protect beneficiaries.”[1]

As explained by CMS, “[t]he overarching purpose of the enrollment process is to help confirm…

On April 21, in a “Hearing on Protecting Patients and Taxpayers: Cracking down on Medicare Fraud,” the House Ways & Means Committee received testimony on hospice and home health fraud from Sheila Clark, President and Chief Executive Officer of the California Hospice and Palliative Care Association,[1] and Chris Deery, the Director of Corporate Fraud…

In a March 3 letter addressed to Gov. Kathy Hochul, CMS Administrator Dr. Mehmet Oz raised pointed concerns about fraud, waste and abuse (“FWA”) within New York’s Medicaid Program involving payments for home health-related services. 

In his letter, Dr. Oz states:

Recent public reporting, federal prosecutions, and CMS analyses raise serious concerns about New York’s…

Maternal health has received increased attention in federal and state Medicaid reform efforts in recent years, particularly in states with elevated mortality and disparity metrics.[1] As Medicaid agencies and managed care organizations consider alternative ways of structuring prenatal care, some providers are expanding services beyond traditional clinic settings.

Nest Health recently launched Nest Origin…

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…

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services recently issued an unfavorable Advisory Opinion (No. 25‑12) addressing a home health care agency’s proposal to offer sign‑on bonuses to prospective employees who are in a position to refer patients (usually family members) to the employer for home care. The…

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…