Home-care fraud & the law

We take fraud seriously — because it steals from taxpayers, endangers vulnerable patients, and hurts the honest providers who do this work the right way. This page explains, in plain terms, what the law forbids and shows real, public consequences here in Southern California.

Isang mabilis na salita sa pag-iwas sa pandaraya

Habang ikinukumpara mo ang pangangalaga, makakatulong na malaman ang mga pulang bandila. Ang isang mapagkakatiwalaang tagapagbigay ay hindi ka kailanman babayaran upang maging o manatiling kanilang pasyente, mag-aalok ng pera o regalo upang mag-sign up, hihilingin na gamitin ang iyong Medicare o Medi-Cal number para sa mga serbisyong hindi mo natatanggap, o magpapadala ng bayarin para sa mga pagbisita na hindi nangyari. Ang pagbabayad sa sinuman kapalit ng mga referral ng pasyente ay isang pederal na krimen sa ilalim ng Anti-Kickback Statute (42 U.S.C. § 1320a-7b) — para sa tagapagbigay at, sa ilang mga kaso, para sa pasyenteng tumatanggap ng bayad. Kung may nag-aalok sa iyo ng pera upang gamitin ang kanilang mga serbisyo, sabihin hindi, at iulat ito.

Ang mga pederal na batas sa pandaraya at pang-aabuso (HHS-OIG) · Iulat ang pinaghihinalaang pandaraya sa Medicare

What the law forbids

A handful of federal and California laws govern how care paid for by Medicare and Medi-Cal may be referred and billed. The most important:

Federal Anti-Kickback Statute (42 U.S.C. § 1320a-7b). It is a felony to knowingly pay OR receive anything of value to induce referrals of services covered by a federal health program. Both sides — the payer and the receiver — can be prosecuted, and that includes paying a patient to enroll.
False Claims Act (31 U.S.C. §§ 3729–3733). Billing Medicare or Medi-Cal for services that were not provided, not medically necessary, or for patients who did not qualify creates civil liability for up to three times the loss plus penalties. Whistleblowers can sue on the government's behalf.
Physician Self-Referral “Stark” Law (42 U.S.C. § 1395nn) and EKRA (18 U.S.C. § 220). Additional federal limits on referrals tied to a financial relationship, extending in some cases to privately-insured patients.
California law (Welfare & Institutions Code § 14107.2; Business & Professions Code § 650). State crimes mirror the federal kickback and referral-fee prohibitions for Medi-Cal and for licensed professionals.
Program exclusion. Beyond prison, fines, restitution, and forfeiture, the HHS Office of Inspector General can bar an individual or company from ever billing Medicare or Medicaid again — often ending a career or a business.

This is not theoretical — real Southern California cases

These are matters of public record, reported by the U.S. Department of Justice and the HHS Office of Inspector General. They involve home health and Medicare fraud prosecuted right here in the Los Angeles area.

A Los Angeles home-health agency operator

A registered nurse who ran GreatCare Home Health in Los Angeles admitted paying illegal kickbacks to doctors, to marketers (“cappers”), and to patients themselves to sign up for services many did not qualify for — then billing Medicare about $5 million. She was sentenced to 57 months in federal prison and ordered to repay $5.14 million; a doctor who took kickbacks in the scheme was also sentenced.

U.S. DOJ, Central District of California · HHS Office of Inspector General

A physician

A Lancaster, California doctor was sentenced to 42 months in federal prison for his role in a Medicare kickback conspiracy involving a Los Angeles-area home-health agency, and was ordered to forfeit more than $500,000. Accepting payment for referrals is a crime for the doctor, not only the agency.

U.S. DOJ, Office of Public Affairs

An Inland Empire agency owner

A Fontana woman whose home-health agency paid more than $1.25 million in illegal kickbacks for Medicare patient referrals was sentenced to 30 months in federal prison and ordered to pay restitution.

U.S. DOJ, Central District of California

These are illustrative public examples, not an exhaustive list. The full record of enforcement actions is published by the agencies below.

Verify a provider & report fraud

Check whether a person or company has been barred from Medicare/Medicaid in the HHS-OIG List of Excluded Individuals/Entities (LEIE).
Report suspected fraud to the HHS-OIG Hotline, to Medicare at 1-800-MEDICARE, or to the California DHCS Medi-Cal fraud line.
Never accept money, gifts, or free services in exchange for your Medicare or Medi-Cal number, or for becoming a patient — and never give your number to someone who offers it. If it feels off, it probably is.

This page is general education, not legal advice, and case summaries are drawn from public government announcements. Consult a qualified attorney about any specific situation.