By Clifford E. Barnes and Marshall E. Jackson, Jr.

Recent enforcements in home health fraud have highlighted the need for home health companies of every state to engage the State Medicaid payment agency in pro-active affirmative discussion to work together to identify issues related to fraud and abuse.  Such discussions will provide home health companies further insight regarding compliance with federal and state fraud and abuse laws. That being said, recent enforcement actions have shown that home health companies may be liable under fraud and abuse laws, despite efforts to comply with such laws.  

On September 9th Lewis J. Levine a chiropractor practicing in Washington, DC pleaded guilty to signing fake prescription for services to be provided by DC Medicaid in exchange for cash.  According to the plea agreement, Dr. Levine prepared prescriptions and approved and recertified plans of care for Medicaid beneficiaries brought to him by Personal Care Aids who worked for several home care agencies.  Dr. Levine was paid by beneficiaries and personal care aids $75 to $150 for each home health service he prescribed.  The home care agency was unaware of the payments to the Dr. Levine.  Under District of Columbia law, only physicians and advanced practice registered nurses can order home health services for Medicaid.  As a chiropractor, Dr. Levine was neither a physician or advanced practice registered nurse and cannot practice medicine.  In addition, Dr. Levine was not enrolled as a provider in DC Medicaid.  Nevertheless for more than 2 years Dr. Levine and company were able to execute a scheme against home health companies and the DC Medicaid Agency.  Even though Dr. Levine was not legally or medically qualified and could not determine whether the services prescribed were medically necessary, Dr. Levine signed intakes and plans of care.

For the home health companies whose services are denied and who did not participate in the scheme, it does not matter for the State Medicaid Agency that such companies were totally unaware of the scheme and could not reasonably know of such scheme.  For these non-participating companies, it is incumbent to not only remain diligent in efforts to comply with fraud and abuse laws, but to also develop a dialogue with the State Medicaid Agency to find ways in which they can work together to detect fraud and ensure that providers referring for home health services are legally and medically qualified to determine if such services are necessary. 

Is your home health agency involved in proactive discussions with your Medicaid policy office?

Back to Health Law Advisor Blog

Search This Blog

Blog Editors

Related Services



Jump to Page


Sign up to receive an email notification when new Health Law Advisor posts are published:

Privacy Preference Center

When you visit any website, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalized web experience. Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.

Strictly Necessary Cookies

These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms. You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.

Performance Cookies

These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.