“He goes, 'Oh, isn't there a lot of fraud in those areas?' ” Dombi recalled the driver saying.
It wasn't what Dombi, a vice president at the National Association for Home Care and Hospice, hoped to hear. “You don't want to end up with a reputation like that,” he said.
That's part of the reason Dombi's organization has supported the U.S. Justice Department's efforts to curb home healthcare fraud in recent years. The home-care industry has been the focus of numerous fraud investigations, settlements and judgments. That's related to the proliferation of home healthcare agencies, the relative ease of committing fraud through them, and increased scrutiny by federal prosecutors, experts say.
The government and the home-care industry have been working to combat fraud by putting a hold on approving new centers in some areas of the country, capping certain types of government payments to agencies and using data analyses to uncover foul play. Some say the move toward value-based payments and away from fee-for-service might make committing such fraud more difficult, while others say it may just change the character of the fraud.
“Home healthcare is under the microscope now,” said Mark Silberman, a partner with Duane Morris in Chicago who represents home healthcare agencies. “I have no reason to believe those efforts won't continue.”
About half of Justice's current healthcare fraud caseload involves home healthcare allegations, said Peter Carr, a Justice Department spokesman. Dombi estimates he's seeing a new indictment or conviction on an almost weekly basis.
Home-care, durable medical equipment, and mental healthcare are the three biggest areas for healthcare fraud, said Marc Smolonsky, a consultant who works on healthcare fraud issues and formerly served as an HHS associate deputy secretary responsible for healthcare fraud operations. Home care, he said, is an easy target for fraudsters, who can bill Medicare for many types of services under the umbrella of home care. “Once you have access to beneficiaries, you can submit all sorts of bills using their beneficiary numbers,” he said.