Owner of Home Health Companies Receives Prison Sentence in Fraud Prosecution

Home health workers provide a valuable service to people who have difficulty meeting their personal or medical needs due to age or infirmity. Each year, programs such as Medicare and Medicaid devote billions of dollars to reimburse companies within this industry. Unfortunately, the nature of this type of work persuades some unscrupulous business owners to pad their bottom line by presenting fraudulent claims to the government. 

For example, an Ohio woman who owned three home healthcare businesses was sentenced to 42 months in prison and forced to pay back Medicaid $5.7 million for services that were not provided. Sally Njume-Tatsing’s conviction stemmed from several specific forms of misrepresentation frequently associated with home health aide services, such as:

  • Overstating hours — In many cases, only the aide and client are present during visits. Some providers take advantage of this by submitting claims to Medicare or Medicaid that seek payment for more hours than the employee actually worked. 

  • Misrepresenting qualifications — Reimbursement for medical services is sometimes based partly on the qualifications of the employee who assisted the patient. To increase the amount her companies received, Ms. Njume-Tatsing falsified claims by saying work was done by registered nurses when the employees were actually licensed practical nurses. 

  • Billing for ineligible patients — Claims were submitted for care provided to patients who were either deceased or ineligible for Medicaid benefits. 

Another factor that contributes to home healthcare fraud is the fact that many employees in this industry work on a temporary basis or frequently move from one company to another. Aides might also fear that they will be fired or suffer some other type of retaliation if they contact authorities regarding their employer’s fraudulent actions. 

It’s important to remember that whistleblowers who report fraud involving government programs such as Medicaid and Medicare are legally protected against retaliation and can obtain a portion of the funds collected by the government as a result of the information they provide. Kardell Law Group has successfully represented whistleblowers in the medical industry and other fields for decades. You can rely on us for honest, effective counsel if you’ve noticed improper conduct while on the job.