Why home health is a fraud target
Medicare pays billions for home health services based on physician certifications and visit documentation. Agencies that bill for care never delivered or that do not meet eligibility rules can submit false claims at scale.
Typical schemes
Ghost visits — billing for nurses or therapists who never saw the patient — improper face-to-face certifications, upcoding visit types, and kickbacks to referring physicians or hospitals are recurring patterns in enforcement actions.
Insiders who see the problem
Schedulers, field clinicians, billing staff, and quality reviewers often know when visit logs do not match reality or when patients do not meet homebound requirements.
Reporting and rewards
Tips to CMS or OIG may trigger audits. Systematic fraud may support a qui tam case with potential relator rewards. Document patterns lawfully and consult counsel before removing records. This guide is educational, not legal advice.