A Missouri home healthcare company has agreed to pay $534,475 to settle allegations that it submitted false Medicaid claims, US Attorney Thomas C. Albus announced on Nov. 24, 2025.
The government alleges that the company billed Medicaid for applied behavior analysis services performed between Oct. 1, 2022, and May 31, 2023, by an individual who began as a contractor and later became an employee. According to prosecutors, the company should have known the worker inflated his educational credentials and claimed to provide more than 24 hours of services in a single day. The individual was allegedly not qualified to perform the assessments and treatment plans he billed for.
The employee left the company in May 2023. In July, the company disclosed concerns about his conduct and cooperated with investigators. It denies knowing that he was submitting false claims.
“[This] settlement underscores a commitment to holding providers accountable for submitting false information and fraudulent claims to the Medicaid program,” said Linda T. Hanley, Special Agent in Charge with the Department of Health and Human Services Office of Inspector General. “HHS-OIG, alongside our law enforcement partners, will continue to protect taxpayer funds and ensure patients receive legitimate services from properly licensed individuals.”
Compliance Perspective
Issue
Healthcare providers are responsible for ensuring that services billed to Medicaid, Medicare, and other payers are accurately documented, properly supported, and delivered by individuals who meet all required qualifications. When oversight processes are unclear or inconsistently followed, organizations are at greater risk of submitting inaccurate or unsupported claims.
Discussion Points
- Review facility policies to ensure they clearly outline who may provide, document, and bill for specific services, and that they define the qualifications required for each role. Policies should also address supervision expectations, documentation standards, and steps for verifying staff credentials before services are billed. Facilities may find it beneficial to periodically review these policies with their compliance team or in collaboration with an external consultant who can help identify gaps, recommend updates, and ensure alignment with current regulatory expectations.
- Provide regular training for staff involved in service delivery, documentation, and billing. Education should reinforce the importance of accurate recordkeeping, working within licensure and scope-of-practice requirements, and recognizing documentation or workflow inconsistencies that may signal the need for further review. Med-Net Academy offers the course Staying on Top of Employee Checks, which covers the Office of Inspector General Exclusion List, the List of Debarred Contractors, employee licensing and certification checks, and employee background screening.
- Conduct routine audits to confirm that services billed were actually provided, properly documented, and performed by qualified personnel. Audits should evaluate whether documentation supports the codes billed, whether credentialing requirements are met, and whether any discrepancies require corrective action. In some circumstances, organizations may choose to have an independent review performed by an external consultant to obtain an unbiased assessment of their processes, identify emerging risks, or prepare for regulatory review. Regular auditing supports ongoing compliance and helps address issues before they result in financial or legal consequences.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*