Home Health

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…

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…

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 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…

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.…