Home Health Fraud Defense
Former DOJ Fraud Section Prosecutors. Nationwide Defense for Home Health Agency Owners, Nurses, Physicians, Executives, and Healthcare Professionals Facing Federal Home Health Fraud Investigations and Charges.
Based in Washington, D.C., Armstrong & Bradylyons PLLC defends home health agency owners, directors of nursing, registered nurses, certifying physicians, healthcare executives, marketers, and other individuals in federal home health fraud investigations and cases nationwide.
The firm’s healthcare fraud defense practice is built on nearly a decade of combined experience at the nation’s preeminent healthcare fraud enforcement unit: the Healthcare Fraud Unit of DOJ’s Fraud Section. Scott Armstrong, Drew Bradylyons, and Andrea Savdie tried 17 federal jury trials in healthcare fraud cases at DOJ’s Fraud Section involving over $2.8 billion in alleged false and fraudulent claims to federal healthcare programs. The firm uses that experience to defend home health agency owners and their employees at every stage of a federal case: from the first audit or grand jury subpoena, through federal indictment, and at trial.
Home health fraud is one of the longest-running enforcement targets of the Medicare Fraud Strike Force. The firm defends individuals in the Strike Force districts where home health enforcement is most active: the Southern District of Florida, the Eastern District of Michigan, the Southern District of Texas, the Central District of California, the Northern District of Illinois, the Eastern District of New York, and the District of Massachusetts.
Armstrong & Bradylyons PLLC defends every home health fraud case from the start as if it will go to trial. That is not a slogan. It is the operating principle of the firm, grounded in 25 federal jury trials in complex fraud cases in federal courts across the country.
Trial experience drives results at every stage. Home health fraud cases are data-intensive and document-heavy. They involve OASIS assessments, face-to-face encounter documentation, physician certifications of homebound status, plans of care, visit notes, and allegations that patients were not homebound, that services were not rendered, or that patient referrals were driven by kickbacks. The firm builds the factual record from the first day of engagement: analyzing claims data, retaining clinical experts, identifying and preparing witnesses, and developing a case theory that can withstand the government’s scrutiny.
The firm’s attorneys know how federal prosecutors build healthcare fraud cases because they built them. Scott Armstrong served for nearly a decade at DOJ’s Fraud Section, where he served as lead trial counsel in 16 federal jury trials, including complex healthcare fraud cases involving Medicare, Medicaid, and Tricare. Scott also directed DOJ’s Appalachian Regional Prescription Drug Task Force. Drew Bradylyons served as Chief of EDVA’s Financial Crimes and Public Corruption Unit and, before that, supervised the Healthcare Fraud Unit’s Miami Strike Force at DOJ’s Fraud Section. That combined experience provides the firm with an unmatched understanding of how federal healthcare fraud cases are investigated, charged, and tried.
The firm relishes the opportunity to try cases. Its willingness to go to trial and its proven skills at trial provide significant leverage in negotiations with federal prosecutors at every stage of a home health fraud case.
Home health fraud has been a top federal enforcement priority for over a decade. It remains one. The Medicare Fraud Strike Force was built in part on home health fraud prosecutions, and the government continues to target home health agencies with aggressive criminal and civil enforcement actions.
Medicare home health spending exceeds $17 billion annually. That spending is concentrated in specific geographic markets, and the government uses claims data analytics to identify agencies with utilization patterns that diverge from national norms. Los Angeles County alone accounts for approximately 18% of the nation’s total home health and hospice Medicare billing activity. A member of Congress has called on CMS to revalidate enrollment information for every home health provider in Los Angeles County and impose a temporary moratorium on new enrollments in California.
The criminal prosecutions are severe. In January 2025, a Massachusetts home health agency operator was sentenced to 12 years in federal prison and ordered to pay $99.7 million in restitution for a scheme that siphoned over $100 million from MassHealth. In August 2025, a Houston home health agency owner was sentenced to 75 months in federal prison after a three-day trial for falsifying medical records and bribing a physician to approve home health services. These are not outlier cases. Strike Force prosecutors and U.S. Attorney’s Offices across the country are actively investigating and prosecuting home health fraud.
CMS suspended $5.7 billion in suspected fraudulent Medicare payments in 2025 by leveraging advanced analytics and cross-agency coordination. CMS revoked the billing privileges of 5,586 providers and suppliers and sent 372 fraud referrals encompassing $3.7 billion in billing to law enforcement. The government’s new Health Care Fraud Data Fusion Center combines data from DOJ, HHS-OIG, FBI, and CMS to detect anomalous billing in real time. Home health agencies with utilization outliers are being identified faster than ever before.
Home health agency owners, directors of nursing, certifying physicians, marketers, and healthcare executives face real and immediate exposure to federal criminal and civil enforcement. Billing errors, documentation deficiencies, and aggressive patient recruitment practices that may have gone unnoticed for years are now under active federal scrutiny.
The firm’s home health fraud defense practice is built on healthcare fraud trial experience, deep knowledge of Medicare home health certification requirements and billing rules, and years of experience investigating and prosecuting complex healthcare fraud cases at DOJ’s Fraud Section. These tools are deployed at every phase of a case.
Challenging the Government’s Billing and Utilization Analysis
Federal home health fraud cases are built on Medicare claims data. The government identifies agencies with unusually high per-episode reimbursement, high utilization of therapy visits, disproportionate clinical group and comorbidity coding under the Patient-Driven Groupings Model (PDGM), rapid growth in patient census, and billing patterns that diverge from peer averages in the same geographic market. The firm challenges the government’s data at every level: the selection of comparators, the methodology used to identify outliers, the assumptions underlying utilization analyses, and the conclusions drawn from aggregate billing patterns. High utilization is not fraud. The firm ensures that distinction is drawn clearly and forcefully.
Homebound Status, Medical Necessity, and OASIS Defense
The government’s case often hinges on the claim that patients were not homebound, that skilled services were not medically necessary, or that OASIS assessments were inflated to generate higher reimbursement under the PDGM. The firm retains qualified home health clinical experts to review patient records, OASIS assessments, plans of care, and visit documentation. These experts can establish that the patient met the homebound standard at the time services were provided, that skilled nursing or therapy services were medically necessary, and that OASIS scoring was clinically accurate and supported by the patient’s documented condition.
Face-to-Face Encounters, Certification, and PDGM Billing Rules
Medicare home health billing is governed by a complex regulatory framework. Eligibility requires a physician certification that the patient is homebound and requires skilled services under a plan of care. A face-to-face encounter with the certifying physician or qualifying practitioner must occur within specified timeframes. The PDGM, effective since January 2020, assigns 30-day payment periods based on clinical groupings, functional levels, and comorbidity adjustments derived from OASIS data. The firm analyzes the applicable certification requirements, face-to-face encounter rules, and PDGM coding standards to challenge the government’s interpretation. Regulatory complexity and ambiguity in homebound status determinations are powerful defense tools.
Challenging the Government’s Proof of Knowledge and Intent
Federal healthcare fraud requires proof of willful and knowing fraud. Clinical judgments about homebound status, medical necessity, and OASIS scoring involve professional discretion. The firm builds the factual record to demonstrate that the agency acted in good faith, that clinical staff exercised legitimate professional judgment, and that the agency did not intend to defraud Medicare. Where the government relies on cooperating witness testimony to establish intent, the firm attacks the reliability, credibility, and motivations of those witnesses. The firm’s attorneys have extensive experience cross-examining cooperating witnesses in federal healthcare fraud trials.
Federal home health fraud investigations target individuals at every level of the agency’s operations: from the owners and executives who control the business, to the nurses who conduct assessments and deliver care, the physicians who certify patients and sign plans of care, and the marketers who recruit patients. Armstrong & Bradylyons PLLC defends these individuals in federal investigations, after indictment, and at trial.
Defense of Home Health Agency Owners and Operators
The firm defends the founders, owners, and operators of home health agencies in federal fraud, Anti-Kickback Statute, and money laundering investigations and prosecutions. Agency owners are the primary targets of federal enforcement. Prosecutors pursue owners who allegedly directed the enrollment of patients who were not homebound, designed compensation structures that incentivized inflated OASIS scoring, paid kickbacks for patient referrals, submitted claims for services not rendered, or used nominee owners to conceal felony convictions that would disqualify the agency from Medicare enrollment. The firm defends agency owners by challenging the government’s evidence of personal knowledge, direction, and intent.
Defense of Directors of Nursing and Registered Nurses
The firm defends directors of nursing, registered nurses, licensed practical nurses, and other clinical staff in federal home health fraud investigations and cases. Nurses face criminal exposure when the government alleges that they inflated OASIS assessments to generate higher reimbursement, fabricated visit notes for visits not conducted, documented skilled nursing needs that did not exist, or participated in schemes to enroll patients who were not homebound and did not require skilled services. The firm defends nursing professionals by challenging the government’s clinical evidence and establishing the legitimate clinical basis for the nurse’s assessments and documentation.
Defense of Certifying Physicians
The firm defends physicians who certify home health eligibility, sign plans of care, and conduct or authorize face-to-face encounters. Physicians face criminal exposure when the government alleges that they certified patients as homebound without adequate clinical evaluation, signed plans of care for patients they never examined, conducted sham face-to-face encounters, or received kickbacks for patient referrals and certifications. The firm defends certifying physicians by challenging the government’s evidence and establishing the legitimate medical basis for the physician’s certification decisions.
Defense of Marketers and Patient Recruiters
The firm defends home health marketers, community liaisons, and patient recruiters in federal investigations. Marketers face criminal exposure when the government alleges that they recruited patients who were not homebound, paid kickbacks to physicians, hospital discharge planners, assisted living facility operators, or other referral sources for patient referrals, or received compensation tied to the volume of referrals in violation of the Anti-Kickback Statute. The firm defends marketers by challenging the government’s evidence of knowledge, intent, and the nature of the compensation arrangement.
Defense of Healthcare Executives and Investors
The firm defends healthcare executives, management company operators, and investors in home health agencies. Federal prosecutors and the False Claims Act are reaching individuals beyond the direct service providers: corporate executives, management services organization (MSO) operators, and investors who exercised operational control over agency operations. The firm defends these individuals against fraud, conspiracy, money laundering, and kickback charges arising from the operations of home health organizations.
Federal home health fraud investigations follow a pattern. Understanding that pattern is the first step to defending against it. Scott Armstrong and Drew Bradylyons built these types of cases as senior prosecutors at DOJ’s Fraud Section. They know how federal investigators identify targets, develop evidence, and present cases to grand juries.
Claims Data Analytics and PDGM Utilization Review
The investigation typically begins with data. HHS-OIG, CMS, and the FBI use claims data analytics and AI-driven tools to identify home health agencies with anomalous billing patterns. The government flags agencies with per-episode reimbursement rates that exceed market averages, unusually high therapy utilization, disproportionate coding of high-reimbursing clinical groups and comorbidity adjustments under the PDGM, rapid growth in patient census relative to workforce capacity, high percentages of patients with LUPA (Low Utilization Payment Adjustment) episodes suggesting phantom billing, and geographic clustering in markets identified as oversaturated. The Health Care Fraud Data Fusion Center deploys advanced analytics to detect these patterns in real time.
OASIS Assessment Audits
Federal investigators scrutinize OASIS (Outcome and Assessment Information Set) assessments submitted by home health agencies. OASIS data drives reimbursement under the PDGM. The government examines whether OASIS scoring was clinically accurate or inflated to generate higher payment. Investigators compare OASIS functional and clinical assessments against physician records, hospital discharge summaries, and other independent clinical documentation. Agencies whose OASIS scoring consistently places patients into higher-reimbursing clinical groups and comorbidity tiers than peer agencies in the same market are flagged for investigation.
Homebound Status and Face-to-Face Encounter Review
Medicare home health services require that the patient be confined to the home. The government investigates whether patients were actually homebound at the time services were provided. Investigators conduct surveillance, review social media, interview patients and their family members, and compare agency documentation against other evidence showing the patient was not homebound. The government also scrutinizes face-to-face encounter documentation to determine whether the certifying physician or qualifying practitioner actually met with the patient within the required timeframe and whether the encounter documentation supports the patient’s homebound status and need for skilled services.
Patient and Employee Interviews
Federal agents interview current and former employees, patients, patients’ family members, and referral sources. They look for cooperating witnesses who can testify about the agency’s actual operations: whether patients were actually homebound, whether visits were actually conducted, whether OASIS assessments were inflated at the direction of management, whether documentation was fabricated, and whether marketers paid kickbacks for patient referrals. Cooperating witnesses are a cornerstone of federal home health fraud prosecutions. They provide the narrative that connects data anomalies to individual intent.
Kickback and Patient Recruitment Analysis
The government investigates patient recruitment practices and referral relationships. In home health fraud cases, federal prosecutors examine whether agencies paid cash kickbacks to physicians for patient certifications and referrals, paid kickbacks to hospital discharge planners, assisted living facilities, or community organizations for patient referrals, compensated marketers on a per-referral or per-patient basis, or entered into sham medical directorship or consulting agreements with certifying physicians. Kickback allegations under the Anti-Kickback Statute (42 U.S.C. § 1320a-7b) carry independent criminal penalties and taint every claim submitted for patients referred through the kickback arrangement.
Search Warrants for Electronic Devices and Cloud Accounts
Federal agents routinely seek and execute search warrants for cell phones, laptops, tablets, and cloud-based accounts in home health fraud investigations. These warrants target communications between agency owners, nurses, physicians, marketers, and billing staff that reveal knowledge of fraudulent billing, directives to inflate OASIS assessments, discussions about kickback payments, and efforts to conceal the true operations of the agency. Federal agents obtain cloud warrants under 18 U.S.C. § 2703 of the Stored Communications Act and serve them directly on Apple, Google, and other service providers.
Search Warrants for Electronic Medical Records and Patient Files
The government also executes search warrants and issues grand jury subpoenas to seize electronic medical records (EMRs) and patient files directly from home health agencies and EMR vendors. Federal investigators use EMR data to reconstruct the agency’s documentation practices across the entire patient population. They compare OASIS assessments and visit notes against billing records, analyze timestamps and metadata to determine whether documentation was created contemporaneously or fabricated after the fact, and identify patterns of templated notes or copy-and-paste documentation that may indicate visits were not individualized to the patient or were not actually conducted. EMR metadata is a critical tool for federal prosecutors in home health fraud cases.
Federal home health fraud enforcement is concentrated in Medicare Fraud Strike Force districts with high volumes of home health billing activity and established healthcare fraud infrastructure. Home health fraud was one of the original enforcement targets when the Strike Force program was created in 2007. Armstrong & Bradylyons PLLC defends home health agencies in every one of these jurisdictions.
Southern District of Florida
The Southern District of Florida is the historic epicenter of home health fraud enforcement. South Florida was the birthplace of the Medicare Fraud Strike Force, and home health fraud was one of the first enforcement targets when the program launched. The district has produced dozens of home health fraud convictions with sentences ranging from five to twenty years. South Florida’s high concentration of home health agencies and its elderly patient population make it the highest-risk jurisdiction for home health providers.
Eastern District of Michigan
The Eastern District of Michigan is one of the original Strike Force districts. Detroit has a long history of home health fraud enforcement, including prosecutions involving phantom patients, falsified visit notes, and kickback schemes tied to physician referrals. The district’s experienced Strike Force prosecutors have tried numerous home health fraud cases to verdict.
Southern District of Texas
The Southern District of Texas is a Strike Force district with aggressive home health fraud enforcement. In August 2025, a Houston home health agency owner was sentenced to 75 months in federal prison for falsifying medical records and bribing a physician. Texas is one of the largest home health markets in the country, and Strike Force prosecutors in Houston and the Rio Grande Valley have extensive experience with home health fraud prosecutions.
Central District of California
The Central District of California is a Strike Force district with significant home health enforcement activity. Los Angeles County accounts for approximately 18% of the nation’s total home health and hospice Medicare billing. CMS and DOJ have publicly announced intensified investigations of healthcare billing fraud in California, and congressional representatives have called for a temporary moratorium on new home health enrollments in Los Angeles County. Home health agencies operating in Southern California face heightened enforcement risk.
District of Massachusetts
The District of Massachusetts has emerged as a major home health fraud enforcement jurisdiction. In January 2025, a Massachusetts home health agency operator was sentenced to 12 years in federal prison and ordered to pay $99.7 million in restitution for a scheme that siphoned over $100 million from MassHealth. DOJ expanded its Health Care Fraud Strike Force into the District of Massachusetts in September 2025, deploying specialized prosecutors to the region.
Additional Districts
Home health fraud enforcement extends well beyond the districts above. The Northern District of Illinois, the Eastern District of New York, the Northern District of Texas, the Middle District of Florida, and the District of New Jersey all have active home health fraud enforcement. As the Health Care Fraud Data Fusion Center expands its analytic capabilities, the government’s ability to identify billing outliers across all geographic markets will continue to grow. Scott Armstrong and Drew Bradylyons defend home health agencies in every federal district where DOJ, CMS, and HHS-OIG bring home health fraud cases.
Federal home health fraud prosecutions draw on several criminal statutes. The charges carry severe penalties. Understanding the statutory framework is essential to mounting an effective defense.
Healthcare Fraud (18 U.S.C. § 1347)
The primary charging statute in home health fraud cases. Healthcare fraud makes it a federal crime to knowingly and willfully execute or attempt to execute a scheme to defraud any healthcare benefit program. In home health cases, this statute targets billing for services not rendered, billing for patients who are not homebound, inflating OASIS assessments to generate higher reimbursement, and falsifying visit documentation. The penalty is up to 10 years of imprisonment per count. If the fraud results in serious bodily injury, the maximum increases to 20 years. If it results in death, a life sentence is possible.
Wire Fraud (18 U.S.C. § 1343)
The government frequently charges wire fraud alongside or as an alternative to healthcare fraud. Wire fraud applies to any scheme to defraud that uses interstate wire communications, which includes the electronic submission of Medicare claims. Wire fraud carries a maximum penalty of 20 years of imprisonment per count.
Anti-Kickback Statute (42 U.S.C. § 1320a-7b)
The Anti-Kickback Statute is at the center of many federal home health fraud prosecutions. It prohibits offering, paying, soliciting, or receiving anything of value to induce or reward the referral of patients for services covered by federal healthcare programs. In home health cases, prosecutors target kickbacks paid to physicians for patient certifications and referrals, kickbacks to hospital discharge planners, assisted living facility operators, and other referral sources, and compensation tied to referral volume disguised as marketing or consulting fees. Violations carry up to 10 years of imprisonment per violation.
Money Laundering (18 U.S.C. §§ 1956, 1957)
Money laundering charges are common in large-scale home health fraud prosecutions. The government charges money laundering when it alleges that defendants conducted financial transactions involving the proceeds of the home health fraud scheme with the intent to conceal or promote the underlying fraud. Money laundering carries up to 20 years of imprisonment per count.
False Claims Act (31 U.S.C. §§ 3729–3733)
The False Claims Act is the government’s primary civil enforcement tool. It imposes liability on any person who knowingly submits or causes the submission of false or fraudulent claims to the government. In home health fraud cases, the FCA targets claims for patients who are not homebound, claims for services not rendered, and claims tainted by kickback relationships. Penalties include treble damages and per-claim penalties. FCA cases may be brought by the government directly or by private whistleblowers through the Act’s qui tam provisions.
Federal Program Exclusion and Collateral Consequences
Beyond incarceration and fines, a conviction or settlement in a home health fraud case triggers mandatory exclusion from Medicare, Medicaid, and all federal healthcare programs under the authority of HHS-OIG. For nurses and physicians, exclusion effectively ends a career. CMS may also revoke the agency’s Medicare enrollment and impose a re-enrollment bar. State licensing boards may initiate independent disciplinary proceedings.
What Should I Do If My Home Health Agency Is Under Federal Investigation?
Retain experienced federal defense counsel immediately. Do not speak with federal agents, CMS auditors, HHS-OIG investigators, or anyone else about the investigation before consulting a defense attorney.
Federal home health fraud investigations frequently begin with a grand jury subpoena, agent contact from the FBI or HHS-OIG, a CMS audit or prepayment review, a Unified Program Integrity Contractor (UPIC) review, or a sealed qui tam whistleblower lawsuit. What you say and produce in the early stages of an investigation shapes the entire case.
Scott Armstrong and Drew Bradylyons defend home health agency owners and medical professionals at the investigation stage and at trial, drawing on years of experience as senior prosecutors at DOJ’s Fraud Section.
What Home Health Documentation Does the Government Scrutinize?
Federal investigators focus on specific documentation in home health fraud cases. The government scrutinizes OASIS (Outcome and Assessment Information Set) assessments, including whether functional and clinical scoring is supported by the clinical record. Investigators review face-to-face encounter documentation to determine whether the certifying physician actually met with the patient within the required timeframe. Physician certifications of homebound status and need for skilled services are examined against independent evidence.
Plans of care, visit notes, skilled nursing assessments, therapy visit documentation, and discharge summaries are all subject to review. The government looks for templated or copy-and-paste notes, inconsistencies between visit notes and billing records, documentation that does not reflect the patient’s actual condition, and notes that were created or modified after the dates of service. PDGM coding is scrutinized to determine whether clinical group and comorbidity adjustments were supported by the patient’s documented diagnoses and functional limitations.
What Are the Penalties for a Federal Home Health Fraud Conviction?
The penalties are severe. Healthcare fraud (18 U.S.C. § 1347) carries up to 10 years of imprisonment per count. Wire fraud carries up to 20 years per count. Money laundering carries up to 20 years per count. Anti-Kickback Statute violations carry up to 10 years per violation.
Beyond incarceration, defendants face substantial fines, restitution orders, and forfeiture of assets. Federal law mandates exclusion from Medicare, Medicaid, and other federal healthcare programs upon conviction. Recent home health fraud sentences include 12 years for a Massachusetts operator ($99.7 million restitution) and 75 months for a Houston agency owner.
What Is OASIS and Why Does It Matter in Home Health Fraud Cases?
OASIS (Outcome and Assessment Information Set) is a standardized assessment tool that home health agencies must complete for every Medicare patient. OASIS data drives reimbursement under the Patient-Driven Groupings Model (PDGM). OASIS assessments capture the patient’s functional limitations, clinical conditions, and service needs, which CMS uses to assign the patient to a clinical group, functional level, and comorbidity tier that determines the 30-day payment amount.
Federal investigators scrutinize OASIS scoring to determine whether agencies inflated functional limitation scores, clinical condition coding, or comorbidity adjustments to generate higher reimbursement. Agencies whose OASIS scoring consistently places patients into higher-reimbursing groups than peer agencies in the same market are flagged for investigation. The government uses OASIS data as the foundation for its billing fraud theory.
What Is the Homebound Requirement and How Does It Create Fraud Exposure?
Medicare home health services require that the patient be confined to the home. The homebound standard requires that leaving the home requires a considerable and taxing effort due to the patient’s condition. A patient can still be homebound if they leave the home for medical appointments, religious services, or occasional trips of short duration. The standard is not absolute confinement.
Homebound status is one of the most commonly disputed issues in federal home health fraud cases. The government conducts surveillance, reviews social media, and interviews patients and their families to determine whether patients were actually homebound. Agencies that enroll patients who are clearly not homebound face the most severe enforcement exposure. A defense attorney experienced in home health fraud can challenge the government’s evidence and establish that the patient met the homebound standard based on the clinical record.
What Defenses Are Available in a Federal Home Health Fraud Case?
The available defenses depend on the specific allegations. Common defenses include the following:
Homebound status. The homebound standard involves clinical judgment. Defendants can present clinical evidence that the patient met the homebound requirement at the time services were provided.
Medical necessity. Defendants can challenge the government’s claim that skilled services were not medically necessary. Plans of care, physician orders, and clinical documentation support this defense.
OASIS accuracy. Defendants can retain clinical experts to validate that OASIS scoring was consistent with the patient’s documented condition and supported by the clinical record.
Good faith reliance. Reliance on compliance programs, legal counsel, or CMS guidance can negate the element of intent.
Challenging data analysis. The government relies on claims data analytics. Aggregate billing patterns do not prove fraud at the individual patient level.
Scott Armstrong and Drew Bradylyons leverage their significant federal trial experience as former prosecutors to anticipate the government’s trial strategy and develop an aggressive, evidence-based defense.
What Triggers a Federal Home Health Fraud Investigation?
Federal home health fraud investigations are typically triggered by claims data analytics identifying billing outliers, CMS prepayment reviews or UPIC audits, qui tam whistleblower lawsuits filed under the False Claims Act, complaints from current or former employees, complaints from patients or their families, and referrals from state Medicaid Fraud Control Units or other regulatory agencies.
Common red flags include unusually high per-episode reimbursement, high therapy utilization relative to peer agencies, disproportionate coding of high-reimbursing PDGM clinical groups and comorbidity tiers, rapid growth in patient census, and geographic concentration in markets identified by CMS as oversaturated.
What Is the Difference Between a Civil and Criminal Home Health Fraud Investigation?
Civil home health fraud investigations focus on recovering money. These may involve False Claims Act actions, Civil Investigative Demands (CIDs), and penalties including treble damages and per-claim fines.
Criminal home health fraud investigations focus on proving intentional and willful fraud beyond a reasonable doubt. Criminal cases carry the possibility of imprisonment, criminal fines, and restitution.
The government frequently runs civil and criminal investigations in parallel. Statements and concessions made in a civil matter or audit response can be used to build a criminal case. Scott Armstrong and Drew Bradylyons have years of experience navigating parallel civil and criminal healthcare fraud cases at DOJ’s Fraud Section and as defense attorneys.
Can a Home Health Agency Owner Be Held Personally Liable for Fraud by Employees?
Yes. Federal prosecutors regularly pursue home health agency owners and executives for fraud committed within their organizations. The owner does not need to have personally submitted false claims or conducted patient assessments. If a provider causes another person to submit a claim with knowledge that the claim is false or fraudulent, a criminal case against that provider may be viable.
The government relies on theories of conspiracy (18 U.S.C. § 371) and aiding and abetting (18 U.S.C. § 2) to reach individuals who directed or designed the fraudulent scheme.
Can a Certifying Physician Be Charged with Home Health Fraud?
Yes. Certifying physicians face federal criminal exposure in home health fraud cases. The government charges physicians who allegedly certified patients as homebound without adequate clinical evaluation, signed plans of care for patients they never examined, conducted sham face-to-face encounters, or received kickbacks for patient certifications and referrals.
A defense attorney experienced in home health fraud understands how to challenge the government’s clinical evidence and establish the legitimate medical basis for the physician’s certification decisions.
Does Armstrong & Bradylyons PLLC Handle Home Health Fraud Cases Outside of Washington, D.C.?
Yes. Armstrong & Bradylyons PLLC defends individuals in federal home health fraud investigations and prosecutions nationwide. The firm can practice in every federal district court in the country.
Home health fraud enforcement is concentrated in Strike Force districts including the Southern District of Florida, the Eastern District of Michigan, the Southern District of Texas, the Central District of California, the Northern District of Illinois, the Eastern District of New York, and the District of Massachusetts.
Scott Armstrong and Drew Bradylyons have tried healthcare fraud cases and handled investigations in Strike Force districts and federal courts across the country. The firm is based in Washington, D.C. and represents clients in every jurisdiction where DOJ, CMS, and HHS-OIG investigate and prosecute home health fraud cases.