Texas Has Highest Rate of Suspicious Home Healthcare Billing

Because of a very high rate of suspicious Medicare billing practices among Texas home healthcare providers, some have advocated freezing the enrollment of new home healthcare providers until the questionable practices are brought under control. According to the Fort Worth Star-Telegram. Texas alone accounted for almost 40 percent of the nation’s suspicious billings. Among the state’s 2,212 home healthcare agencies, 45 percent filed suspicious billings to the Medicare program, a rate five times higher than the national average.

Florida’s questionable billings accounted for 25 percent of the nation’s total, but the state’s rate of suspicious billing was even higher than Texas at almost six times the national average.

According to a recent report by the U.S. Department of Health and Human Services’ inspector general, the problems included:

  • Double-dipping, so that Medicare was charged for hospital and nursing-home stays at the same time; and
  • Billing for deceased patients;

However, the Centers for Medicare and Medicaid Services (CMS), which administers funds and monitors home healthcare agencies, has stated that these particular issues account for approximately $5 million. That amounts to under .03 percent of Medicare claims.

Acting CMS administrator Marilyn Tavenner, has said that she agrees that a freeze on new provider enrollment would be appropriate temporarily in both Texas and Florida.

Home healthcare services appear to be particularly vulnerable to waste, fraud, and abuse. The HHS report found, for example, that 22 percent of this year’s home healthcare claims were erroneously submitted and resulted in improper payments totaling $432 million.

False claims against the federal programs like Medicare create a serious drain on public funds, and federal authorities must rely in many cases on information provided by whistleblowers to prosecute Medicare and Medicaid fraud. Because the participation of whistleblowers is so important, the qui tam provision of the False Claims Act provides that whistleblowers may file lawsuits on behalf of the government and then share in any recovery obtained.


Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.

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