Home Healthcare Fraud, Waste, and Abuse Library

Purpose of this Live Article:

As your premier resource for combating fraud, waste, and abuse, PCG aims to update this home healthcare fraud article every time the OIG and local officials arrest and convict those who attempt to defraud our US healthcare system and cheat our taxpayer contributions, including but not limited to wage‑parity violations, kickback schemes, false claims, unqualified staff, and fraudulent patient certifications.

Home Healthcare is a target of Fraud

The U.S. home health care sector delivers critical services to elderly and disabled patients in their homes and communities. Public programs like Medicare, Medicaid, and the Energy Employees Occupational Illness Compensation Program (EEOICP) reimburse agencies for skilled nursing, therapy, hospice, personal care, and other services. The field’s rapid growth, however, has been accompanied by significant fraud, waste, and abuse (FWA). Between 2022 and 2025, federal authorities, state attorneys general, and whistleblowers exposed schemes ranging from forged physician signatures and unqualified aides to illegal wage underpayments and kickbacks. These enforcement actions reveal systemic vulnerabilities in home health oversight and offer lessons for payers and compliance professionals.

2025 Home Healthcare Fraud Cases

$534k - Deer Valley Home Health Services - Nov 2025

The U.S. Attorney’s Office for the Eastern District of Missouri announced that DVHH agreed to pay $534,475 to settle False Claims Act allegations. Investigators found that a contractor falsely inflated her credentials and billed Medicaid for more than 24 hours of services per day, leading to unqualified care and overstated hours. DVHH cooperated and repaid the government while the employee faced exclusion.

Source: DOJ Report

Action: Settlement, company cooperated, unqualified provider barred.

$55 Million - Americare - Home Healthcare Fraud - Dec 2025

New York’s Attorney General secured a record $55 million settlement requiring Americare to return nearly $45 million in unpaid wages to over 10,000 home health aides and pay $10 million to Medicaid. Investigators found that from 2014 to 2020, the agency systematically underpaid aides in violation of the state’s Wage Parity law while still billing Medicaid as if wages were paid. The settlement includes an enforceable payment schedule and mandated compliance training.

Sources: AGNY

Action: Settlement, restitution, and policy reforms ordered.

$20k Civil Penalties - AccurCare Home Health - Sep 2025

AccuCare paid $20 000 under a civil monetary penalty for employing an excluded individual who provided services billed to federal health programs.

Source: OIG Report

Action: CMP and Affirmative Exclusions

75 Months Prison & $400k+ - Paul Njoku - Aug 2025

A federal court in Houston sentenced home health agency owner Paul Njoku to 75 months in prison for Medicare fraud and identity theft. He forged physicians’ signatures by cutting and taping them onto documents, bribed a doctor to falsely certify patients, and directed staff to prepare fake records; his company submitted more than $400 000 in fraudulent claims and received over $360 000.

Source: OIG Report

Action: CMP and Affirmative Exclusions

$334k - M&Y Care LLC - July 2025

The home health company agreed to repay $334 807 to the U.S. and Michigan to settle claims that, between 2015 and 2023, it billed Medicare and Medicaid using CPT code G0156 for non‑skilled services delivered by untrained staff. The complaint alleged the unqualified personnel should have been billed under personal care codes, which pay less. The case began from a whistelblower.

Source: OIG Report

Action: Settlement, no admission of liability.

35k+ - CareLink Home Health - June 2025

CareLink paid $35 597 to resolve allegations that it employed an excluded nurse and case manager whose services were billed to federal programs.

Source: OIG Report

Action: Settlement, minor CMP

54 Months Prison & $1.49M - Lilit Gagikovna Baltaian

A Los Angeles physician was sentenced in absentia to 54 months in prison for falsely certifying patients for home health care between 2012 and 2018. Court documents show she pre‑signed blank certifications and received cash payments to allow four home health agencies to bill Medicare for services not medically necessary, causing $1.49 million in losses.

Source: OIG Report

Action: Sentencing, the fugitive remains a fugitive but is hunted by the US Marshals and the FBI.

42 Months Prison & $5.7M - Sally Njume Tatsing - April 2025

Sally Njume‑Tatsing (Labelle Home Health), Ohio – Owner Sally Njume‑Tatsing was sentenced to 42 months in prison and ordered to pay $5.7 million in restitution for Medicaid fraud. She inflated service hours, billed for registered nurses when work was done by licensed practical nurses, and billed for services provided to deceased or ineligible patients.

Source: OIG Report

Action: Sentencing; agencies barred from Medicaid

$3M - Saad Enterprises - Feb 2025

Saad agreed to pay $3 million to settle allegations it billed Medicare for hospice patients who were not terminally ill. The settlement resolved False Claims Act allegations that from 2013 to 2020, Saad admitted and recertified 21 patients without proper eligibility. Former employees who blew the whistle will receive $540 000 of the recovery.

Source: OIG Report

Action: Settlement, the company denied liability but paid.

12 Years Prison & $99.7M - Faith Newton - Jan 2025

The operator of a home health agency was sentenced to 12 years in prison and ordered to pay $99.7 million in restitution and a $250 000 fine. Between 2013 and 2017, she orchestrated one of the largest home health frauds in U.S. history by billing MassHealth for services not provided, paying kickbacks for patient referrals, forging training documents, and pressing doctors to sign false plans of care. Officials described the scheme as a theft of resources from both taxpayers and vulnerable patients.

Source: IRS Report

Action: Sentencing and Restitution is underway.

$9.99M - Atlantic Home Health Care LLC - Jan 2025

Atlantic Home Health Care and its principal agreed to pay $9.99 million to resolve allegations of false claims to the EEOICP. From 2017 to 2021, the company billed for in‑home nursing and personal care when caregivers were not present and paid kickbacks disguised as a “friends and family” program. This case originated from a whistleblower.

Source: DOJ Report

Action: Settlement; compliance monitoring imposed.

2024 Home Healthcare Fraud Cases

$3.9M - Edison Home Health Care - Sept 2024

Two Brooklyn agencies admitted they underpaid home health aides in violation of New York’s Wage Parity Act while still seeking Medicaid reimbursement. They paid $3.9 million to the United States, $5.85 million to New York State, and $7.5 million to current and former aides.

Source: DOJ Report

Action: Settlement, wage parity compliance required.

$10.1M - RiverSpring / ElderServe - Sep 2024

The New York Attorney General obtained a $10.1 million settlement from RiverSpring Health Plans and its affiliate ElderServe Home Care. Investigators found that from 2012 to 2017, the plan billed Medicaid for home health services that were never provided; $6 million of the settlement was returned to the Medicaid program.

Source: Attorney General NY Report

Action: Settlement, oversight of the managed care plan imposed.

$19.4M - Gentiva/Kenred at Home - July 2025

Hospice (successor to Kindred at Home) and related entities agreed to pay $19.428 million to resolve allegations that they submitted false hospice claims and retained overpayments. The government alleged that from 2010 to 2020, they provided hospice services to patients who were not terminally ill and concealed obligations to repay Medicare; some locations also paid a consulting physician for referrals, violating the Anti‑Kickback Statute.

Source: DOJ Report

Action:  Settlement, corporate integrity agreement implemented.

$4.4M - Guardian Health Care - July 2025

Guardian Health Care and related entities paid $4.496 million to settle allegations that they paid illegal kickbacks to assisted living facilities and physicians from 2013 to 2022. The companies allegedly provided lease payments, wellness services, sports tickets, and meals in exchange for Medicare referrals. This case was brought forth by self-disclosure and cooperation.

Source: DOJ Report

Action:  Settlement, Anti-Kickback education required.

$9.9M - Atlantic Home Health Care - Jan 2024

Atlantic Home Health Care and its principal agreed to pay $9.99 million to resolve allegations of false claims to the EEOICP. From 2017–2021 the company billed for in‑home nursing and personal care when caregivers were not present and paid kickbacks disguised as a “friends and family” program.

Sources: DOJ Report

Action: Settlement; compliance monitoring imposed.

$99.9M - Faith Newton - Arbor Homecare - Jan 2024

The operator of a home health agency was sentenced to 12 years in prison and ordered to pay $99.7 million in restitution and a $250 000 fine. Between 2013 and 2017, she orchestrated one of the largest home health frauds in U.S. history by billing MassHealth for services not provided, paying kickbacks for patient referrals, forging training documents, and pressing doctors to sign false plans of care.

Sources: DOJ Report

Action: Sentencing and Restitution underway.

Breakdown of Fraud Schemes

Illegal Kickback and Referral Payments

Multiple enforcement actions from 2022–2025 revealed home health agencies paying illegal kickbacks to physicians, patient marketers, and assisted living facilities in exchange for Medicare and Medicaid referrals. These inducements were often disguised as consulting fees, lease payments, “chart reviews,” wellness services, meals, or entertainment, directly violating the Anti-Kickback Statute and, in some cases, the Stark Law. Carter Healthcare, Guardian Health/Evolution Health, and the Omorogbe-owned agencies exemplified how referral payments distorted clinical decision-making and inflated program costs.

These schemes shifted patient placement away from medical necessity and toward financial incentives, undermining beneficiary protections and increasing federal healthcare spending. Regulators consistently emphasized that even indirect or non-cash benefits tied to referrals constitute unlawful remuneration when they influence patient selection.

False Claims for Unqualified or Unnecessary Services

A recurring enforcement theme involved billing for services that were either medically unnecessary or delivered by unqualified personnel. Several agencies submitted claims for hospice or home health services for patients who did not meet eligibility criteria, including individuals who were not homebound or not terminally ill. Saad Healthcare, Kindred/Gentiva, Atlantic Home Health Care, and M&Y Care all billed Medicare or Medicaid based on false certifications or misuse of skilled service codes.

Other cases involved outright impossibilities, such as billing for more than 24 hours of care per day or using untrained aides while billing skilled nursing codes. These false claims diverted limited program funds away from legitimate care and increased risks to patients who either received inappropriate services or were deprived of necessary oversight.

Wage Parity and Labor Violations

Some of the most significant financial recoveries stemmed from wage-parity violations and labor law violations directly tied to Medicaid billing. In these cases, agencies certified compliance with state wage laws while systematically underpaying home health aides, then billed Medicaid as if full wages had been paid. Americare’s $55 million settlement and similar actions involving Edison and Preferred Home Health Care highlighted how labor violations can rise to the level of fraud when false attestations support government claims.

Regulators treated these cases as both worker exploitation and taxpayer fraud, requiring restitution to aides, repayments to Medicaid, and mandated compliance reforms. The enforcement actions reinforced that payroll integrity is a material condition of payment when providers seek reimbursement from public health programs.

Fraudulent Certifications and Identity Theft

Physician certifications serve as the gateway to home health and hospice reimbursement, making them a focal point for fraud. Several high-profile cases involved forged, pre-signed, or coerced physician orders used to justify billing for ineligible patients. Paul Njoku physically altered documents and bribed a physician, while Lilit Baltaian pre-signed blank forms that agencies later completed without medical review. Faith Newton relied on fabricated records and sham employment relationships to support false claims.

These schemes compromised patient safety and program integrity by removing independent medical judgment from eligibility decisions. Courts consistently treated falsified certifications as aggravating conduct, resulting in lengthy prison sentences and substantial restitution orders.

Managed Care and Plan Failures

Fraud was not limited to individual agencies; managed care organizations and federally administered programs were also implicated. RiverSpring and ElderServe billed Medicaid for home care services that were never provided, while United Energy Workers Healthcare submitted claims to the Department of Labor for unnecessary or nonexistent services under the EEOICP program.

These cases exposed oversight gaps in managed care and alternative benefit structures, where reliance on delegated administration and provider attestations reduced visibility into service delivery. Regulators emphasized the need for stronger monitoring controls in managed long-term care and federal benefits programs.

How the Fraud Schemes Worked

Home health fraud typically combined falsified documentation with financial incentives. Forged or pre-signed physician orders unlocked reimbursement, while kickbacks disguised as rent, consulting, or perks steered patients toward complicit agencies. Once enrolled, patients were frequently recertified regardless of medical need to sustain ongoing billing.

Agencies also exploited staffing and payroll opacity by using unqualified or excluded workers, misrepresenting visit hours, or underpaying aides while billing full reimbursement rates. These tactics leveraged blind spots inherent in home-based service delivery and self-reported compliance.

Summary of Home Healthcare Fraud

Enforcement Decisions and Actions

The enforcement actions documented in this library demonstrate that home healthcare fraud, waste, and abuse remain a persistent and systemic threat to U.S. healthcare programs. Recent federal and state cases reveal a consistent pattern of misconduct across the sector, including illegal kickbacks for patient referrals, falsified physician certifications, billing for unqualified or nonexistent services, wage-parity violations tied to Medicaid claims, and failures within managed care oversight. These schemes were not isolated errors but multi-year operations that exploited the trust-based structure of home-based care and the reliance on provider attestations.

Enforcing and Reclaiming 100s of Millions in Losses

From 2024 through 2025 alone, authorities secured hundreds of millions of dollars in settlements, restitution orders, and wage recoveries, while imposing significant prison sentences on agency owners, executives, and physicians. Courts and regulators repeatedly emphasized that fraud in home healthcare harms not only taxpayers, but also vulnerable patients who depend on medically appropriate, properly staffed care. The severity of penalties and the breadth of cases underscore a clear enforcement priority: home healthcare is no longer a low-risk environment for abuse, and violations are increasingly met with criminal prosecution, corporate integrity agreements, exclusions, and long-term compliance monitoring.

Exposing and Fixing Vulnerabilities

Collectively, these cases expose structural vulnerabilities in home healthcare programs — decentralized service delivery, fragmented oversight, paper-based certifications, and limited real-time verification — while also providing a roadmap for detection and prevention. For payers, regulators, and compliance leaders, this body of enforcement serves as both a warning and a reference point: fraud in home healthcare follows identifiable patterns, leaves detectable financial and operational signals, and carries escalating legal consequences when left unaddressed.

Using AI Auditing to Prevent Home Healthcare Fraud

As home healthcare fraud becomes more sophisticated and enforcement intensifies, traditional audit models that rely on post-payment sampling and retrospective reviews are no longer sufficient. Artificial intelligence enables a fundamentally different approach by analyzing 100% of claims, every day, rather than a small subset after funds have already been paid. At a high level, AI-driven auditing platforms such as Virtual Examiner® allow payers and program administrators to continuously monitor billing patterns, documentation signals, referral relationships, wage compliance indicators, and service utilization across entire populations. By identifying anomalies, inconsistencies, and high-risk behaviors in near real time, AI reduces dependence on delayed enforcement and whistleblower-driven discovery, helping organizations limit non-compliance before it escalates into large-scale fraud. The result is a shift from reactive recovery to proactive prevention — strengthening program integrity, protecting patients, and preserving taxpayer dollars without disrupting legitimate care delivery.