Health Agency Allegedly Defrauds Medicare

Medicare Expert WitnessThis case takes place in Connecticut and involves alleged fraud in Medicare. The defendants owned and operated a home health care agency that employed nurses to provide complimentary medical services at assisted living facilities, offering free blood pressure and vital sign checks to the residents. These nurses would then conduct assessments for the potential patients that were Medicare insured. These forms were allegedly manipulated to appear as though Medicare beneficiaries were home-bound and in need of nursing services. The defendant’s agency billed Medicare for home health services without physician examination of the patients. The defendants usually sent a letter to the patients’ primary care physicians to provide documentation that the patients had been seen by the primary care physicians after the start of care by the home health agency’s nursing staff. Often, the primary care physicians would not respond to the letter; however, those that did respond said that the patients were not homebound or in need of home health services. The defendants purportedly continued to bill Medicare for these services.

Question(s) For Expert Witness

  • 1. Have you ever served as an expert witness on a case similar to the one described above? If so, please explain.
  • 2. Could you please discuss your background with regards to the Medicare coverage and regulation, specifically as it relates to home healthcare?

Expert Witness Response E-009670

I would be happy to assist on this case. I have been involved with Medicare law for more than 20 years, and I am definitely familiar with all of the ins and outs of the policies and regulations, specifically as it relates to home healthcare. I am the co-author of “Medicare Handbook,” a lead trainer at the CT Health Insurance Counseling and Assistance Program, and have instructed at numerous national conferences regarding Medicare law and home healthcare. I spent 17 years at the Center for Medicare Advocacy as an attorney and currently serve as the director of consulting and regulatory affairs at a home healthcare management solutions company.

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