Home health aide fraud

What it is

A home health agency bills Medicare or Medicaid for skilled nursing, physical therapy or personal-care aide visits that are inflated, fabricated outright, or built on a patient who was never eligible for the benefit in the first place. Unlike a one-off scam using a stolen Medicare number for a single item, home health billing is recurring: once a doctor certifies a patient as homebound and in need of skilled care, an agency can submit a claim for every visit, or every 60-day episode of care, for as long as the certification and the paperwork hold up. That payment structure, bill for a certified, enrolled patient rather than for independently verified care actually delivered, is what the scheme exploits, whether the underlying visits are exaggerated, partly real, or entirely invented.

How it actually works

1. The recruitment

   A patient recruiter, working inside a hospital discharge office, senior center, church or apartment complex, signs up Medicare or Medicaid beneficiaries for home health services, sometimes paying them directly, in cash or gift cards, for their enrollment information.

2. The kickback

   The home health agency pays the recruiter a flat fee or a share of future billings for every patient who ends up enrolled, independent of whether that patient actually needs home health care.

   Where it could have stopped

   Paying or accepting money for a patient referral violates the federal Anti-Kickback Statute on its own, before a single Medicare or Medicaid dollar is ever billed. Prosecutors in the documented cases here charged the kickback payments as separate counts from the underlying billing fraud.

3. The homebound certification

   A physician, sometimes paid by the agency per signature, certifies that the patient is homebound and needs skilled nursing, therapy or aide services, often without examining the patient or basing the certification on a diagnosis supplied by agency staff rather than an independent exam.

4. The visit notes

   Aides, nurses or office staff complete daily or per-visit notes describing skilled care that was delivered, sometimes by cutting signatures off old documents and pasting them onto newly created ones, including the signature of staff who no longer work there, regardless of whether anyone actually visited that day.

5. The claim

   The agency submits a claim per visit, or per 60-day episode of care, to Medicare or Medicaid. The program pays on the strength of the certification and the documentation submitted, not on independent proof that the visit happened or that the care was needed.

6. Covering the gaps

   When the program requests the underlying records, or investigators interview an aide or a patient, operators in the documented cases here directed staff to create or backdate charts, timesheets or visit logs rather than let an incomplete or nonexistent file be reviewed.

7. Enforcement, built from the claims themselves

   HHS Office of Inspector General investigators, the FBI, state Medicaid Fraud Control Units and, since 2026, dedicated Health Care Fraud Strike Force teams build cases from billing data itself: aides billed for more hours in a day than exist, visits logged for patients who were hospitalized, incarcerated or overseas at the time, and kickback payments traced through bank records. In the cases documented here, that process took months to several years to reach a charge, conviction or sentence.

Why it works

Medicare and Medicaid pay on certification and paperwork, not on proof of care. Like most large insurance programs, both pay home health claims in the first instance on the provider’s own documentation, with detailed audits, if they happen at all, coming later, which is exactly the gap every case on this page exploited for months or years before being caught.

The targeted patients are the ones least likely to catch it. Elderly, homebound or isolated beneficiaries with limited family oversight of their Medicare or Medicaid statements are easy to enroll and unlikely to notice or object to a visit that was logged but never happened.

The workforce itself is reusable. Home health aides and nurses are often transient and paid relatively little, so a name, license number or signature can keep appearing on records long after the real person has left the agency, as happened in the documented case where a departed nurse’s signature was used for two more years without her knowledge.

A per-visit or per-episode payment model rewards billing volume, not hours of real care. An agency paid the same whether a visit runs the full scheduled time or a fraction of it has every incentive to log the full visit regardless of what actually happened.

Electronic Visit Verification closes one gap but not the next one. A federal requirement since the 21st Century Cures Act, phased in across states between 2019 and 2023, logs an aide’s time and location at a visit’s start and end, making it harder to bill for a visit that never happened at all. It does not verify what happened during the visit, and the falsified-paperwork and false-certification versions of this scheme continue to show up in cases charged well after EVV’s rollout.

Where it comes from

Entirely domestic: this scheme exploits Medicare’s and Medicaid’s own home health benefit, which does not exist outside the United States in this form, so every documented case here is a US case.

Regulators have been describing this exact pattern since at least 1995. The HHS Office of Inspector General’s June 1995 Special Fraud Alert on home health agencies already listed claims for visits not made, kickbacks disguised as salaries or referral fees, high-pressure recruitment of healthy beneficiaries, and claims for patients who were not actually homebound, three decades before the cases documented on this page.

Texas produced the largest and longest-running scheme documented here. Fiango Home Healthcare, a married couple’s Houston-area agency, ran the recruitment-kickback-certification cycle from February 2006 through June 2015, submitting more than $13 million in false claims before its co-owners were sentenced to 75 and 80 years, one of them in absentia after fleeing to Cameroon.

Home health and hospice are now a named federal enforcement priority. In 2026 the Justice Department’s Fraud Division named home health and hospice among its top targets, citing plans to use data analysis to find these schemes, while the Centers for Medicare and Medicaid Services imposed a 6-month moratorium, starting May 13, 2026, on new Medicare home health and hospice provider enrollments to curb fraud, waste and abuse. That same year, a dedicated strike force expansion into the Philadelphia area brought charges against 19 defendants, including home health company owners, employees, purported aides and Medicaid recipients, over more than $4 million in alleged fraud involving impossible or nonexistent billed hours.

Real cases

Red flags

• An unsolicited offer of cash, gift cards or free services in exchange for your Medicare or Medicaid number, or for signing up with a specific home health agency.
• Someone asking for your Medicare or Medicaid card rather than just your signature to arrange home health visits.
• A nurse’s, aide’s or doctor’s signature on a visit note or order for a day you don’t remember anyone visiting.
• Very short visits logged as full-length ones, or visits logged on days you were in the hospital, traveling, or otherwise somewhere else.
• Being offered money to “sign up” for services, or to let someone use your name or Medicare number as a patient.
• A home health agency that reopens under a new name or new ownership shortly after losing its billing privileges or facing an audit.
• Medicare Summary Notices or Medicaid statements showing home health visits, therapy or equipment you never received.

If it’s happening to you

If you or a family member don’t recognize a home health visit, aide or company on a Medicare or Medicaid statement:

1. Call the agency named on the statement and ask for the name of the aide or nurse who visited and the exact dates, then compare that against your own memory or calendar.
2. Never give your Medicare or Medicaid number to anyone offering cash, gift cards or free services in exchange for it, or for enrolling you with a specific agency.
3. Review recent Medicare Summary Notices or Medicaid explanation-of-benefits statements for an agency name you don’t recognize.
4. If you are an aide or nurse and your name is on records for visits you didn’t make, document what you’ve found and report it in writing to the agency’s compliance line and, if needed, your state licensing board.
5. Report what you’ve found to 1-800-MEDICARE (1-800-633-4227), your state’s Medicaid Fraud Control Unit, your local Senior Medicare Patrol, the FBI’s Internet Crime Complaint Center at ic3.gov, or the HHS Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477) or TIPS.HHS.GOV. See where to report for agencies in other countries.

Where the money goes

Entirely domestic, moving from Medicare’s or Medicaid’s own trust funds into the home health agency’s operating accounts, then out again as kickbacks and personal spending.

Medicare or Medicaid pays its per-visit or per-episode rate directly into the agency’s bank account, typically the smallest and most traceable step in the chain, since it comes from a federal or state program with its own records. From there, the agency’s owner or controlling operator pays kickbacks to the recruiters who supplied the patients. In the largest documented case here, the operator also ran a second company with no real operations, billing the home health agency itself for services it never provided, pulling roughly $1 million out of the agency’s accounts under cover of a plausible-looking vendor payment rather than an obvious loss. What’s left moves into personal spending, real estate and, where prosecutors can trace it, forfeited bank accounts.

By the numbers

No published dataset breaks this scheme out as its own category yet, so there is no chart to show. The data page explains which agency categories exist and why some schemes are invisible in official statistics.