In 2024, Intrepid U.S.A., Inc., a nationwide home health and hospice provider headquartered in Dallas, Texas, agreed to pay $3.85 million to resolve False Claims Act allegations affecting both its home health and hospice lines of business. The government alleged that between 2016 and 2021, 19 Intrepid home health facilities submitted claims to Medicare for services provided to patients who did not qualify for the Medicare home health benefit, where the services were not reasonable or medically necessary, where the services were provided by untrained staff, or where the services were not performed at all.
The case was initiated not by regulators, but by former Intrepid employees. Four whistleblowers filed two separate qui tam lawsuits under the False Claims Act, and their inside knowledge of the company’s billing practices drove the investigation that led to the settlement.
What Medicare’s Home Health Benefit Actually Covers
Medicare pays for home health services when specific conditions are met. A physician must certify that the patient is homebound, meaning they have difficulty leaving home without considerable effort, and that the patient requires skilled nursing care or therapy on an intermittent basis. The care must be medically necessary, and qualified staff must actually provide the services.
When a home health agency bills Medicare for a patient who does not meet those criteria, submits claims for visits that never happened, or uses untrained or unqualified employees while billing for skilled care, every one of those claims is a false claim under federal law. The government can recover up to three times the amount it wrongfully paid, plus civil penalties for each false claim submitted.
How Home Health Fraud Schemes Operate
Home health fraud takes several distinct forms, and the Intrepid case illustrates more than one of them at the same time.
Billing for patients who do not qualify is the most common pattern. Agencies admit patients who are not homebound or who do not require skilled care, then submit claims as if all the Medicare criteria were satisfied. Over a patient population of any significant size, the resulting overpayments add up quickly.
Billing for services not rendered is a related scheme. In one case, an Arizona home health agency agreed to pay nearly $10 million to resolve allegations that it billed a federal health care program for nursing and care services when its employees were not physically present in patients’ homes. The government also alleged in that matter that the agency’s referral program paid cash and in-kind payments to generate new patients, adding an Anti-Kickback Statute violation on top of the billing fraud.
Kickbacks for referrals are a third category. The Anti-Kickback Statute prohibits offering or paying anything of value to induce referrals of patients covered by Medicare or Medicaid. Home health agencies have paid kickbacks in many forms: cash payments to physicians, free services to nursing homes in exchange for patient referrals, and purchase agreements structured to generate a flow of patients from the seller. Each referral obtained through a kickback produces a tainted claim, and every tainted claim submitted to Medicare is a false claim.
Who Sees This Fraud From the Inside?
Home health fraud does not occur in isolation. The employees who deliver, document, and bill for services see the discrepancy between what is actually happening and what is being submitted to the government.
- Nurses who visit patients document the care they provide. When they are directed to bill for visits they did not make, or when patients on their caseload clearly do not require skilled care, they have direct, personal knowledge of the fraud.
- Billing staff who process claims for services that were not rendered know the records do not match reality.
- Clinical directors who raise concerns about patient eligibility and are told to proceed anyway have witnessed an attempt to override their professional judgment in favor of false billing.
Any of these employees may have grounds to file a qui tam lawsuit under the False Claims Act on behalf of the United States. When a qui tam action is successful, the whistleblower may be eligible to receive a portion of the government’s recovery. In the Intrepid case, the four relators collectively shared in the settlement proceeds.
The Government Is Actively Pursuing These Cases
Billing for medically unnecessary services and substandard care has been a named priority in DOJ enforcement announcements for multiple consecutive years. In July 2025, the DOJ and HHS relaunched a joint False Claims Act Working Group with kickbacks and Medicare fraud named as priority areas. Private equity ownership of home health agencies has also drawn explicit attention from DOJ leadership, with prosecutors noting that revenue targets and financial pressure from investors can drive the fraudulent billing patterns that trigger FCA liability.
Contact a Whistleblower Attorney Before Taking Action
If you work in home health care and have observed patients being billed who do not meet Medicare eligibility criteria, claims submitted for visits that did not occur, or payments being offered to generate referrals, you may have the foundation for a False Claims Act qui tam claim. These cases require careful handling from the outset, and filing correctly matters.
Contact Keller Grover today to speak with a whistleblower attorney about what you have seen. Our team handles False Claims Act cases and can walk you through your rights and options before you take any other steps.