From the Office of Inspector General (OIG), U.S. Department of
Health & Human Services
Home Health Care Fraud
For Medicare beneficiaries to be eligible for home health care
services, they must be under the care of a physician. The physician must
certify that the beneficiary needs one or more of the following:
physical therapy, occupational therapy, speech language therapy or
intermittent skilled nursing care. Additionally, beneficiaries must be
“home bound.” which means that due to their condition,
leaving them home is not recommended and requires special
transportation, or can only be done with a taxing effort.
How the Scam Works
In the common home health care fraud scheme, no actual home health
therapy is provided. The beneficiary is asked to sign forms that verify
a nurse or therapist showed up at her home and provided
To justify charging for a nurse, a fraudulent physician who is
not the beneficiary’s primary doctor may falsely certify that the
beneficiary is an insulin-dependent diabetic and cannot inject
Unscrupulous physicians may also fraudulently certify that a
beneficiary is home bound. In exchange, the beneficiary will be offered
cash on a monthly basis or provided a home health aide that only
prepares meals or cleans.
How to Fight Back
Billing Medicare for services not provided is highly illegal and you
should report this immediately if you are approached for this scam.
Be cautious when you are offered money or "free" services in
exchange for your Medicare card number.
Reject the services of unscrupulous Medicare providers that use
these fraudulent tactics to obtain your Medicare number and personal
information. They intend to use it for fraudulent billing.