About this Episode

Home health fraud in hotspots like Los Angeles County threatens patients, legitimate providers, and the long-term stability of the Medicare home health program across the country.

In this episode of Who Cares from the National Alliance for Care at Home, host Elyssa Katz sits down with Dr. Steve Landers to unpack home health fraud and what it means for the Medicare home health benefit. They explore how home health fraud in hotspots like Los Angeles County threatens patients, legitimate providers, and the long-term stability of the Medicare home health program across the country.

Dr. Landers starts with a clear, plain-language refresher on what home health really is: supportive medical care at home for people who are homebound, recovering from illness or surgery, or living with serious chronic conditions. Then he zooms in on patterns that might indicate fraud in home health.

While most of the country actually lost home health agencies, Los Angeles County saw an explosion of roughly 900 new agencies. That growth, combined with unusual referral patterns, a lack of low-utilization payment adjustments, and strangely uniform patient diagnoses, points to a potential hotspot of fraudulent activity that could exceed a billion dollars in a single year.

But this isn’t just about numbers. Elyssa and Dr. Landers walk through what home health fraud can look like for real people: patients who never received a visit but had their Medicare number billed, families who feel pressured to sign paperwork they don’t understand, or individuals who are referred for services they clearly don’t need. They explain how certain populations—people living in poverty, those with limited English proficiency, or patients with cognitive or neurological challenges—can be especially at risk.

From there, the conversation moves to the systems-level damage. Fraudulent claims don’t just siphon money from the Medicare Trust Fund; they also get baked into complex budget neutrality formulas that Medicare uses to set Medicare home health payment rates. That means sham providers in one county can distort national data and trigger real cuts for legitimate agencies everywhere—just as those agencies are already struggling with workforce shortages, rising labor costs, and year-over-year rate reductions.

Throughout the episode, Elyssa and Dr. Landers return to a core theme: fix the fraud, not the funding. The Alliance is pushing for targeted action—tighter licensure and certification processes, better vetting of ownership, more on-site surveys, and a laser focus on geographic hotspots like Los Angeles—without unleashing auditors on good providers over minor technicalities.

The episode closes with a powerful story from Advocacy Week, where two frontline clinicians crowdfunded their way to Washington, DC so they could advocate for their community on Capitol Hill. It’s a reminder that home health is deeply valued by patients and families—and that protecting this benefit means rooting out fraud while preserving access to high-quality care at home for everyone who needs it.