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How Does Medicare Handle Home Health Care Fraud and Abuse?
Date Updated: October 29, 2025
Written by:
Sarah has produced thousands of articles in diverse niches over her decade-long career as a full-time freelance writer. This includes substantial content in the fields of senior care and health care. She has experience writing about wide-ranging topics, such as types of care, care costs, funding options, state Medicaid programs and senior resources.
Reviewed by:
Gene Altaffer has a Masters in Gerontology from the University of Southern California and has worked in many avenues along the continuum of long-term care, assisting thousands of clients and their families since 1995. He also sold long-term care insurance from numerous carriers while also assisting families with retirement planning. Gene helps seniors navigate their Medicare plans, ensuring they understand their benefits and options.
Medicare handles home health care fraud and abuse through a range of measures, including investigations and enforcement. If program administrators suspect deception, they may suspend payments, which affects service provisions for individuals. Medicare recipients play a key role in reporting suspected irregularities.
Overview of Medicare Home Health Care Abuse
Abuse and fraud can occur in home health care in several ways, including:
- Home health agencies billing for extra services that weren’t provided
- Providers billing for pricier services than those delivered
- False certification of a patient’s needs for services or homebound status
- Corruption through encouraging providers or patients to use particular services or make certain purchases
For example, an agency bills for four hours of physical therapy when the therapist only delivered two, or it bills for skilled nursing care in place of home health aide services. To reduce the risks of improper practices, Medicare conducts in-depth screening of home health care companies before certifying them and monitors their ongoing compliance with Medicare standards. To identify potential fraud, Medicare educates seniors on how to spot and report unusual activity and ensures providers know how to bill correctly. It also uses analytic programs to catch irregular billing patterns.
How Individuals Can Help to Tackle Fraud
Home health care recipients should always check their Medicare Summary Notices and report any unusual activity. They can seek advice and information from several organizations, including their local Area Agency on Aging and senior law programs. People can also report assumed fraud by calling 1-800-MEDICARE. Additionally, the Senior Medicare Patrol raises awareness of Medicare fraud and empowers older adults and their loved ones to take action.
To stop criminals from using their details in Medicare scams, seniors should avoid disclosing their personal information. They must exercise caution if anyone calls to discuss Medicare matters; if in doubt, contact Medicare directly to check.
Actions Regarding Medicare Fraud and Misuse
The Centers for Medicare and Medicaid Services investigates instances of suspected fraud or abuse involving Medicare home health care. The agency also works with law enforcement organizations. Often, Medicare halts payments to home health care providers during investigations. If Medicare finds instances of fraud, it also seeks to recover overpaid amounts from home health agencies. Fraudulent providers may also face civil and criminal penalties.