Scam targets would-be home health patients


By LPR Staff

Complaints are surfacing across Lockhart of a new group of criminals bent on defrauding the government and using patients trust in their doctors against them.

According to reports received last week, this most recent confidence game begins when the perpetrators approach individuals, usually the elderly, either via telep

hone or door-to-door contact, with a story that the patient’s doctor has referred the patient for home health care. Likely using high-pressure tactics, the scammers convince their targets to turn over their Medicare information, suggesting they will bill the government for services. In most cases, the target never sees the so-called “home health care provider again.”

While the scam usually doesn’t cost the targets any out-of-pocket money, it does create a problem, because often those patients, who need home health at a later time, are unable to receive that care because Medicare has already paid the fake organization for services that, in most cases, are never provided.

The scam is gaining in popularity, and has caused concern among legitimate medical providers, both locally and statewide.

“I hate the fact that there’s nothing we can do to protect our patients except to warn them,” said Jennifer Roberts with Seton Internal Medicine. Because of rules governing distribution of medical and patient information, Roberts was unable to name individuals who have been targeted in the Lockhart area or the company names being used falsely to collect the Medicare benefits.

She did confirm, however, that local patients have been targeted, and asked for patients, caregivers and family members to be aware that this is happening. She also said the easiest way to avoid being taken in is to ask.

“[A doctor] will never refer a patient to home health without discussing it with them, or discussing it with their family,” she said. “Even if a patient is released from the hospital with orders for home health, the primary doctor will be aware of it. So if someone comes to you and says your doctor is putting you on home health care, get their business card and tell them you want to confirm it with your doctor. And then just call the doctor and ask.”

Deborah Troy, a longtime home health nurse and current Executive Director and Director of Clinical Services for Paragon Hospice and Palliative Care in Houston, confirms Roberts’ statement regarding doctor referrals.

“There should never be an instance of ‘cold calling’ a patient and then requesting an order from a physician afterward,” she said. “This would be a violation of the Health Information Portability and Accountability Act (HIPAA), the Federal regulation which guarantees patient privacy in regard to their medical information.”

Additionally, Troy said, a patient always has the right to choose their own provider, even for home health care. While doctors will often have existing professional relationships with agencies and patients will likely trust those referrals, the patient always has the right to ask for other options.

What’s more, she said, reputable agencies will want to have an honest and open relationship with would-be clients, and will not object to answering questions and providing information about their company, and will cooperate in giving patients information about both the orders from the doctors who sent them and the agencies which govern their activities.

“They know that they must obtain informed consent from a patient, prior to providing care,” she said. Informed consent means the patient, knowing what treatment will be provided and why, and being aware of any risks, has agreed to the treatment. Patients have the right to reject treatment and care they do not want.

Both women suggested the safest course of action for any would-be patient to take, upon being contacted by a home health agency offering services is to ask questions. They stressed the idea that home health care will never be of such an urgent need that the patient will endanger themselves or their family members by making a call to their primary doctor to confirm that home health has been ordered. A provider suggesting they need access to patient information immediately, and pressuring a patient to provide that information, should raise “red flags.”

Also, they said, billing Medicare for services not provided is a crime, which is actionable both on state and Federal levels. Patients should pay particular attention to their Medicare summaries, and report immediately any activity they don’t recognize or treatment they did not receive.

Such reports should be made to the the Texas Department of Aging and Disability (DADS), Consumer Rights and Services Division, at P.O. Box 149030, Austin, Texas 78714-9030. Their number is (800) 458-9858. Complaints can also be addressed directly to Medicare at on the web, or by phone to (800) MEDICARE (800-633-4227). TTY users should call (877) 486-2048.


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