The home health sector is an integral part of the healthcare landscape, serving millions of patients each year who might not otherwise be able to access care. On average, about 65 percent of Americans need home care for at least two years—usually when they’re at their most vulnerable healthwise.
Did You Know?
Medicare paid home health agencies $16 billion for home health care provided to about 2.8 million patients in calendar year 2023, according to a 2025 report from the OIG.
There are more than 4.3 million home health caregivers in the U.S., and the majority are caring, qualified individuals who make a positive impact on patients’ lives. But still, home health can be a hotbed of fraud, waste, and abuse for several complex reasons.
This issue recently reached the national stage, with lawmakers calling on the U.S. Department of Health & Human Services Office of the Inspector General (HHS-OIG) to increase home health oversight since these agencies and the communities they serve are “prime targets for fraud.”
Understanding Fraud in Home Health
In fact, Medicaid Fraud Control Units (MFCUs) consistently report that Personal Care Services (PCS) attendants make up a much higher percentage of fraud convictions than any other provider type. In fiscal year 2024, 36 percent of fraud convictions involved PCS attendants, and MFCUs recovered more than $7.2 million in Medicaid funds as a result. For comparison, nurses (including LPNs, RNs, and other nursing licenses) had the next-highest rate of fraud convictions at 11 percent.
Of course, individual PCS attendants are just a piece of the puzzle. Consider the case of Arbor Homecare Services, a home health agency whose former operator was convicted and sentenced to 12 years in prison for a $100 million fraud scheme. This case, like many home health fraud cases, consisted of prescribing unnecessary treatment, billing for services that weren’t provided, and kickback schemes that can be hard to detect.
The same kind of fraud exists in a more typical hospital or health system setting, but the dispersed nature of home health care makes it easier for bad actors to slip through the cracks.
Why Home Health Fraud Is Hard to Catch
Fraud can be harder to detect in home health care simply because there is less direct oversight of caregivers. It’s up to the home health agency to determine who is qualified to enter patients’ homes, and with limited resources, fraudsters can dodge consequences by changing a name or moving states.
In a home health setting, it’s especially important to use more sophisticated tools for basic fraud prevention—like exclusion monitoring that gives full visibility into a person’s eligibility to provide care in every state, not just the one where the home health agency operates.
It takes approximately 420 days for a state Medicaid exclusion to appear on the OIG’s List of Excluded Individuals and Entities (OIG LEIE), and 58% of state exclusions are not currently listed on the OIG LEIE. While not all state exclusions should be included on the OIG LEIE, this lag time makes it all too easy for a bad actor to gain employment in a new state without their employer knowing about a previous exclusion.
It takes a truly comprehensive exclusion monitoring solution that connects and verifies data from all available state and federal primary sources to ensure that an individual isn’t excluded from Medicare or Medicaid.
Finding Solutions That Work Smarter, Not Harder
In an era when many healthcare organizations’ resources are stretched thin, it’s especially important to identify and remove instances of fraud, waste, and abuse before they consume valuable resources.
An automated, accurate exclusion monitoring program is a powerful tool in the fight against fraud in home health and other healthcare settings. With more than 15 years of experience, ProviderTrust has refined a data enrichment strategy that bridges gaps in the data from exclusion sources by attaching unique identifiers to each excluded individual or entity.
This approach allows us to catch more exclusions than any other vendor on the market. In fact, 46 percent of the 45,000+ exclusions we’ve identified could only be found using our proprietary enriched data—meaning that they would’ve gone undetected by other exclusion monitoring solutions.
Ready to see what ProviderTrust can do for your organization? Get in touch with our team today.