A Georgia home health agency owner has been indicted for allegedly defrauding Medicare through a billing scheme involving medically unnecessary services and falsified patient records. According to the U.S. Attorney’s Office for the Northern District of Georgia and the Department of Health and Human Services Office of Inspector General (HHS-OIG), the defendant submitted claims for home health visits that were never performed or were not medically justified.
Authorities allege the agency recruited Medicare beneficiaries through senior centers and community outreach events, offering gift cards and transportation assistance in exchange for enrollment in home health services. Once enrolled, patients were billed for skilled nursing visits, physical therapy sessions, and chronic care management programs regardless of clinical need.
Investigators say patient files were altered to include copied physician signatures and templated progress notes reflecting identical diagnoses and treatment plans across dozens of beneficiaries. Over a three-year period, Medicare paid more than $4.1 million in allegedly fraudulent claims.
The fraud was detected when federal data analysts flagged abnormal billing patterns, including unusually high utilization rates compared to peer agencies and repeated submission of identical service codes across large patient cohorts. A review of electronic health records revealed time stamps indicating overlapping visits across multiple locations.
“Healthcare fraud erodes trust in programs designed to protect our seniors,” said the U.S. Attorney for the Northern District of Georgia. “We will continue using data analytics and cross-agency collaboration to identify and stop these schemes.”
The case underscores the role of real-time utilization monitoring, provider credential validation, and behavioral billing analytics in safeguarding Medicare funds. The defendant faces charges including healthcare fraud, aggravated identity theft, and conspiracy.
Today’s Fraud of the Day is based on reporting from the U.S. Department of Justice and Georgia news outlets regarding Medicare fraud in 2026.
