What do I do if I suspect fraud with a home health care agency?

September 20, 2009 by admin

Most home health agencies are honest, and use correct billing information. Unfortunately, fraud can occur in the home health industry. The best way to protect yourself is to know what Medicare covers, and to know what your doctor has planned for you. If you don't understand something in your care plan, ask questions. You should be alert for:

• Home health visits your doctor orders that you never get.
• Visits by home health staff that aren't needed.
• Bills for services and equipment you never get.
• Faking your signature or your doctor's signature.
• Pressure to accept items and services that you don't need.
• Items listed on your Medicare Summary Notice or Explanation of Medicare Benefits that you don't think you received.

You also should be careful about activities such as:

• Home health services your doctor didn't order. The doctor who approves home health services for you should know you, and should be involved in your care. If your care plan changes, make sure your doctor was involved in making those changes.
• A home health agency that offers you free goods or services in exchange for your Medicare number. Treat your Medicare card like a credit card or cash. Never give your Medicare or Medicaid number to people who tell you a service is free, but they need your number for their records.

To report suspected home health care or Medicare fraud, call 1-800-447-TIPS (1-800-447-8477), or e-mail HHSTips@oig.hhs.gov by e-mail. You can also report suspected home health care fraud to your Regional Home Health Intermediary (RHHI). To get the phone number for the RHHI in your state, visit the Helpful Contacts section of this Web site, select your state, click on "Billing Medicare", then click on the "View Results" button at the bottom.