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WHISTLE-BLOWER GUIDE TO IDENTIFICATION OF HOME HEALTH CARE AGENCY FRAUD ISSUES UNDER THE FEDERAL FALSE CLAIMS ACT 2019By GhostWriter Paralegal, Chartered www.GhostWriterParalegal.com. Ghostwriter Paralegal is not a law firm, but a legal technical research and writing firm that assists law firms with specific needs, as assigned. This Guide was one such assignment. The Guide is also suitable for Home Health Care Agency group discussions and other in house training, or seminars, or break out group exercises, by topic. This guide is a fraud identification tool intended for consideration by a whistle-blower health care professional employed by a home health care agency that is suspected of perpetrating Medicare fraud. Attorneys may also find this detailed technical information useful if involved with home health care agency litigation. This guide can be one tool in your arsenal. The primary purpose of this guide is to aid a home healthcare whistle-blower in the identification of certain specific categories of fraud prevalent in the home health industry in 2019, to identify the types of source documents necessary to prove the frauds identified, and to keep this process as simple as possible, in consideration of the complexity of federal healthcare regulations in general. After reading this guide, if you suspect fraud at your agency, you should immediately consult with a qualified attorney, or report the fraud directly to The United States by calling The Medicare Fraud Hotline 1-800-MEDICARE. There are several bright-line areas of law that are covered in detail in this process. Spoiler Alert! This information is highly technical and boring for most people. Unless you already have a working understanding of home health care agency practices, you will likely hate this book. Conversely, if you have a working knowledge of home health and Medicare guidelines for home health, this book should be an eye opener for you. Four main categories of home health care agency frauds are examined in detail with analysis of specific Medicare regulations and descriptions of exactly how unscrupulous home health care agencies turn these laws upside-down, ultimately resulting in false claims made to Medicare for services that were not provided, were not medically necessary, or both. Lastly an analysis is provided relative to application of information contained within the source documents acquired evidencing home healthcare fraud to four main provisions of The Federal False Claims act and how those Medicare fraud violations can be proven in a court of law. GhostWriter Paralegal is not a law firm, and the topics contained in this publication are intended to foster critical thinking on the subjects presented. As such, the guide, per se, does not constitute legal advice and any such interpretation is completely unintended. If you suspect fraud in your workplace, please consult with a qualified attorney immediately. Once again, you can report suspected Medicare or Medicaid fraud directly to The United States by calling The Medicare Fraud Hotline 1-800-MEDICARE.

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