Home Health Fraud Defense Lawyer
Strategic Legal Defense for Healthcare Providers Accused of Fraud
The home health industry plays a critical role in providing care to New York’s elderly, disabled, and chronically ill populations. However, as the number of home health agencies (HHAs) and home care providers continues to grow, so too has the government’s enforcement focus on home health fraud. Federal and state authorities are increasingly targeting agencies, administrators, and individual practitioners for alleged billing violations, fraud schemes, and improper referral arrangements.
If you are under investigation or have been charged with home health fraud, you need an experienced and aggressive criminal defense attorney on your side. At Sosinsky Law, we represent home health agency owners, executives, nurses, physicians, billing coordinators, and marketers in fraud cases across New York City and the surrounding areas.
With a strong track record defending healthcare professionals in complex fraud investigations and prosecutions, we understand both the legal frameworks and the real-world challenges of operating a compliant home care business. Let us help you protect your license, your reputation, and your freedom.
What Is Home Health Fraud?
Home health fraud refers to any false or misleading action taken by a provider, agency, or employee to improperly obtain payment from Medicare, Medicaid, or other government-funded healthcare programs. This type of fraud can include both civil and criminal conduct and may arise from billing practices, referral relationships, or patient eligibility issues.
Common allegations of home health fraud include:
- Billing for services not rendered
- Upcoding or misrepresenting the level of care provided
- Falsifying patient records to meet eligibility requirements
- Enrolling ineligible patients to receive home health services
- Forging physician signatures on care plans or certifications
- Providing unnecessary care to boost reimbursements
- Kickbacks to marketers or referral sources in violation of the Anti-Kickback Statute
- Ghost visits—documenting nursing or aide visits that never occurred
- Using unlicensed or improperly trained caregivers
Because home health care is often delivered in patients’ homes, these services are less visible to regulators. That has made the industry a major focus of federal enforcement actions, particularly from the Department of Health and Human Services (HHS), Office of Inspector General (OIG), Federal Bureau of Investigation (FBI), and New York State Medicaid Fraud Control Unit (MFCU).
Who Is at Risk in Home Health Fraud Investigations?
In our experience, a wide range of professionals and business entities may be swept up in a home health fraud investigation, including:
- Home Health Agency (HHA) owners and operators
- Skilled nurses and home health aides
- Billing and coding professionals
- Physicians certifying home health plans
- Medical directors and administrators
- Marketers and patient recruiters
- Third-party contractors and consultants
Even if you did not personally submit a false claim, you can be held criminally liable under conspiracy or aiding and abetting statutes. Prosecutors may also target corporate entities and pursue civil monetary penalties, exclusion from Medicaid and Medicare, or asset forfeiture.
Key Laws Used to Prosecute Home Health Fraud
Home health fraud cases may involve violations of both federal and state laws. Some of the most common statutes used in these prosecutions include:
- 18 U.S.C. § 1347 – Healthcare Fraud
Making false statements or claims to obtain payment from a health benefit program. - 18 U.S.C. § 1349 – Conspiracy to Commit Healthcare Fraud
Conspiring with others to commit healthcare fraud, even if you did not personally submit claims. - 42 U.S.C. § 1320a-7b – Anti-Kickback Statute
Prohibits offering or receiving anything of value in exchange for patient referrals. - False Claims Act (31 U.S.C. §§ 3729-3733)
Civil and criminal liability for submitting false or fraudulent claims for reimbursement.
New York Penal Law – Grand Larceny, Falsifying Business Records, Offering a False Instrument for Filing
State-level criminal charges related to home health billing and documentation.
What Triggers a Home Health Fraud Investigation?
Federal and state agencies use various methods to identify suspected fraud in the home healthcare industry. Some common triggers include:
- Medicare or Medicaid audits
- Whistleblower (qui tam) complaints filed by former employees or competitors
- Data mining or analytics showing unusual billing patterns
- Patient complaints or reports of unlicensed caregivers
- Referrals from managed care organizations (MCOs)
- Grand jury subpoenas or search warrants
Once an investigation begins, investigators may seize business records, audit patient charts, and question employees. They may also issue subpoenas or target letters indicating a potential prosecution is underway.
If you’ve received any of these notices—or even if you just suspect that you’re under investigation—it’s crucial to speak with a defense lawyer immediately. The sooner you involve Sosinsky Law, the more options we’ll have to resolve the matter before charges are filed.
Potential Penalties for Home Health Fraud
Convictions for home health fraud can carry serious penalties, including:
- Up to 10 years in federal prison per count (20 years if serious injury is involved)
- Fines of up to $250,000 per count for individuals, and $500,000 for corporations
- Treble damages under the False Claims Act
- Mandatory exclusion from Medicaid and Medicare
- Loss of business licenses, certifications, and professional credentials
- Civil monetary penalties and repayment demands
- Asset seizure and forfeiture
Even in cases that don’t go to trial, a guilty plea or civil settlement can result in lasting professional and financial consequences. Don’t leave your future to chance—contact Sosinsky Law to defend your case the right way.
Our Approach to Home Health Fraud Defense
Sosinsky Law has extensive experience defending clients accused of home health fraud in both federal and state courts. Our approach is comprehensive, aggressive, and tailored to the specific facts of your case.
Step 1: Early Case Assessment
We begin by reviewing subpoenas, audit results, and any communications from investigators. We assess whether the case involves criminal exposure or can be resolved through administrative channels.
Step 2: Gathering Evidence and Building the Record
We conduct our own independent investigation—reviewing billing records, patient files, internal emails, and compliance documents—to develop a full picture of your operations.
Step 3: Engaging with Prosecutors
When appropriate, we open a dialogue with prosecutors or investigators to explain our client’s role, present mitigating evidence, and negotiate a resolution before charges are filed.
Step 4: Assembling a Defense Team
We work with expert witnesses, billing auditors, forensic accountants, and healthcare consultants who can challenge the government’s narrative and support your defense.
Step 5: Trial Preparation
If the case proceeds to trial, we are fully prepared to litigate. We have extensive experience challenging the credibility of whistleblowers, disputing audit findings, and exposing weaknesses in the prosecution’s case.
Why Choose Sosinsky Law?
Proven Experience in Healthcare and Fraud Defense
We’ve represented healthcare professionals, business owners, and medical organizations in complex fraud cases involving millions of dollars in alleged damages. We understand the law and how to defend your rights.
Respected by Prosecutors and Courts
Our firm’s reputation for integrity, preparation, and trial advocacy often leads to favorable resolutions, reduced charges, and pretrial dismissals.
Deep Knowledge of Medicaid and Medicare Regulations
Our understanding of coding practices, care requirements, and documentation standards allows us to challenge fraud allegations at their core.
Personalized, Strategic Representation
We treat each case with the urgency and detail it deserves. No cookie-cutter defenses—just smart, targeted legal work designed to protect your future.
Contact Our Home Health Fraud Defense Lawyer
If you’ve been accused of home health fraud or believe you are under investigation, it’s critical to act fast. These cases are complex, high-stakes, and aggressively prosecuted—but you don’t have to face them alone.
At Sosinsky Law, we provide the experience, resources, and strategic thinking needed to defend healthcare providers in the most serious fraud cases. From initial subpoenas to trial advocacy, our firm will fight to protect your business, your license, and your freedom. Call Sosinsky Law today for a confidential consultation with a New York City home health fraud defense attorney.