In August 2026, the Department of Justice (DOJ) announced a significant expansion of its Northeast Health Care Fraud Strike Force into Philadelphia, teaming with the U.S. Attorney’s Office for the Eastern District of Pennsylvania to expand health care fraud enforcement resources in the region. The move comes after one of the largest health care fraud takedowns in U.S. history and signals a new, sustained enforcement initiative that targets home health care fraud. Home health providers, including physicians, therapists, and home health aides, should understand what this new enforcement initiative means for them and that they will likely face increased scrutiny.

Key Takeaways:

• In June 2026, the DOJ’s new National Fraud Enforcement Division carried out the largest health care fraud takedown in U.S. history, charging 455 defendants nationwide in cases involving more than $6.5 billion in alleged false claims. Home health and personal care agencies were among the highest-risk service lines.
• In August 2026, the DOJ announced a new District Anti-Fraud Initiative that embeds the Northeast Health Care Fraud Strike Force directly in the Eastern District of Pennsylvania. Federal prosecutors charged 19 individuals with home health care fraud involving more than $4 million in allegedly fraudulent Medicare and Medicaid claims.
• Home health care fraud cases are typically prosecuted under 18 U.S.C. §1347 for Health Care Fraud and often overlap with the Anti-Kickback Statute and mail and wire fraud statutes
• A recurring theme in home health fraud cases involves double-billing schemes, billing while on vacation, billing for services not rendered, etc., etc.
• The DOJ and CMS now use AI-powered data analytics and information-sharing agreements with other federal agencies to identify billing outliers before a whistleblower or routine audit surfaces a case.

What the Government Is Actually Looking for in Home Health Cases

The DOJ and Centers for Medicare & Medicaid Services (CMS) have identified recurring themes in home health care fraud cases, including billing for services that were never provided, overlapping or impossible caregiver shifts, care provided while a patient or aide was hospitalized, on vacation or incarcerated, and documentation that does not support the level of service billed.

Medicare reimbursement relies on diagnosis and assessment criteria in the Outcome and Assessment Information Set (OASIS). Federal prosecutors have pursued cases alleging that home health care agencies manipulated OASIS data to trigger a higher reimbursement rate. However, home health care service providers are not the only ones being targeted. Physicians who certify a treatment plan, therapists who document services, and aides who record visits can all face individual exposure.

The Statutes Behind These Cases: Health Care Fraud, Kickbacks, and Stark

The government prosecutes most cases of healthcare fraud under 18 U.S.C. §1347, which criminalizes knowingly executing or attempting to execute a scheme to defraud a health care benefit program. The U.S. Attorney’s Office also relies on the Anti-Kickback Statute and the Stark Law to specifically target home health care providers. The Anti-Kickback Statute prohibits knowingly and willfully offering or paying anything of value to induce referrals under a federal health care program, while the Stark Law restricts certain physician referral relationships tied to a financial interest. These laws are commonly at issue when investigators examine a home health care agency’s referral sources, marketing efforts, or physician relationships.

What’s at Stake Beyond Prison: Exclusion and Practice-Ending Consequences

A conviction for home health care fraud is serious. Consequences often extend beyond fines and jail and can include exclusion from Medicare or Medicaid programs, which can make it nearly impossible for home health care providers to continue operating.

As part of a 2026 enforcement effort, CMS suspended over 1,000 health care providers and revoked Medicare and Medicaid billing privileges for more than 1,000 others. Often, these administrative consequences move more quickly than the criminal case. To protect their livelihoods, home health care providers must consider licensure and billing privileges in addition to the potential consequences of a criminal case.

Contact an Experienced Federal Health Care Fraud Defense Attorney

Investigations of home health care agencies move quickly. Physicians, therapists, home healthcare agencies, caregivers, and nurses who are under investigation for health care fraud should engage experienced legal counsel as soon as they become aware of an investigation, audit, or subpoena.

Federal health care fraud defense attorney Hope Lefeber has over three decades of experience and a track record of success defending doctors, home health agencies, pharmacists, caregivers and other providers charged with health care fraud and other white-collar crimes. Contact the Law Offices of Hope Lefeber to schedule a confidential consultation.