09/01/2026
If you own or manage a private duty or home care company, this one's worth ten minutes.
Elizabeth E. Hogue. has written about the wave of fraud enforcement now hitting our industry, and the examples are genuinely hard to read. Claims billed for caregivers who were in jail, on vacation, driving for delivery apps, or supposedly caring for seven clients at once.
The critical point for owners: enforcers have said they'll pursue wrongdoing wherever it happens, including at the ownership and management level. You will be held accountable for what your employees and contractors do.
More regulation is coming. Fraud enforcement is just the front edge of it.
Read the full article 👇
The Future of Private Duty/Home Care Begins With Fraud Enforcement
Use of private duty/home care services continues to increase. It has become increasingly clear, however, that companies will not be permitted to care for patients who need these services without considerable additional oversight.
The proverbial "bottom line" is that private duty/home care companies will be under greater scrutiny and regulation. The instances of gross mistreatment of patients, some of which we have described in previous articles, are too shocking and lurid. And caregivers about whom lip service is given about their need for support have been mistreated by private duty companies.
And then there's this: The feds are convinced that there is rampant fraud in state Medicaid Programs to the tune of millions, if not billions, of dollars that has not been addressed. The number of fraud strike forces, task forces, etc. targeting companies that provide services to Medicaid recipients are now too numerous to count.
Fraud enforcement is definitely "in fashion" and enforcers are eager to put private duty/home care companies in the color orange! If this a fashion statement you want to make?
To illustrate, the National Fraud Enforcement Division of the U.S. Department of Justice (DOJ) recently announced that it has prosecuted 6200 defendants who collectively billed federal health care programs, including Medicaid, TriCare, the VA and others, $45 billion.
In a press release issued on August 4, 2026, the Division stated:
"Home care fraud is everywhere, and the victim is all of us taxpayers. Medicaid claims date and the experience of veteran prosecutors all point to the systematic exploitation of reimbursable home care programs….Today. we sound the alarm on the scale of this fraud by announcing some truly egregious cases, in which numerous people are charged with filing fraudulent claims for caregivers who were not actually providing home care services, but in fact were dead, in prison, or trafficking drugs. This racket ends today."
And there's more:
"Let todays announcement be a warning to those engaging in similar activity: if you seek to exploit our health care systems for personal profit, you should expect the FBI and our partners to uncover your scheme and bring it to an end. Every dollar stolen through fraud is a dollar diverted from patient care, and the FBI will continue its work to safeguard the public's trust and hold accountable those who abuse these vital programs."
Finally the press release promises that enforcers "…will pursue anybody who seeks to profit at the expenses of American taxpayers, regardless of whether the wrong doing is in the boardroom or in the sickroom."
In other words, it's not just the perpetrators who will be punished. The companies, owners and managers will also face punishment.
So what are some of the offenses pursued so far?
Claims for services while:
- Caregivers were hospitalized or in jail;
- Driving for a ride-share and food delivery service;
- In the midst of a traffic stop in which the caregiver was cited for possession of ma*****na;
- Participating in a sentencing hearing for another individual;
- Posting on social media while on vacation in Miami, Florida;
- Providing care to seven 7 recipients at the same time;
- Rendering care for more than 24 hours in a single day for as many as 400 days; and
- Traveling in Saudi Arabia.
One of the defendants was captured on tape:
"This home health care is the best kept secret…I made a buck plus (each of) the last five years that's that's a half million dollars… ain't checking on nobody."
It may be tempting for owners and managers to say: "That's on them." Not so! Companies and management will be held accountable for the actions of their employers and contractors.
Private duty/home care companies will see a tsunami of regulation. Use of fraud and abuse prohibitions is just the beginning.
