Maxim Health Care Pays $150 Million To Resolve Fraudulent Billing

Maxim Health Care Services provides senior home health care in the home, both insurance reimbursed healthcare visits and private pay home care.  The company uses the name Care Focus and Max Health in some markets for their private duty senior care services.

Improper billing practices were discovered at more than one office, as they conduct business in several states nationwide. Today it was announced that Maxim Health Care Services has agreed to pay $150 million to resolve fraud allegations by the Justice Department and the attorneys general of 42 states.

The home health care company admitted to overcharging Medicaid for six years. Eight former employees at the company have pleaded guilty in connection with the scheme, and some of them face prison time.

One of the challenges in health care is monitoring the billing when there is a third-party company paying the bill, such as Medicaid or Medicare.  In some instances, people who were not receiving Medicaid home care were being billed by Maxim.  As the Maxim managers are paid a bonus based on the profitability of the agency office they are managing, the additional billings resulted in higher incomes for these managers.  They grew profits even more because they were not paying the caregiver and nursing aide salaries since no services were being delivered.

If you have home health services provided by Medicare or Medicaid, ask to review the invoices.  The government is using technology to improve upon the current systems to lesson fraud.  Billions have been paid out for fraudulent claims.

Aneesh Chopra, Chief Technology Officer for the U.S. government, has developed innovation programs to stimulate new information solutions to be developed to help reduce the high cost of managing the operations of the government health care programs and to eliminate fraud. 

Keep an eye on senior care fraud and ask questions about the billing for any services you receive and report any fraud instances you think are happening to the Office of Inspector General Hotline.