Medicare Coverage for Home Health Care: How to Protect Yourself and Hawaii’s Kūpuna

One area where fraud is growing is in home health care — services that should help our seniors live comfortably and safely at home, not open the door to scams​.

Here’s what you need to know to stay safe and protect yourself and your loved ones.

 What Does Medicare Cover for Home Health Services?

Medicare Parts A and B cover short-term, medically necessary home health services when provided by a Medicare-approved agency. These services are coordinated with your doctor and may include:

• Intermittent skilled nursing care

• Physical, occupational, or speech therapy

• Nurse aide care for personal health needs​

To qualify for Medicare home health care:

✅ Your doctor must certify that skilled services are medically necessary.
✅ Your condition should improve with therapy or need maintenance therapy.
✅ You must be considered homebound — meaning you need assistance to leave home or leaving home poses a health risk​.

 Common Home Health Care Fraud Schemes

Scammers exploit Medicare by billing for services that aren’t medically necessary — or not provided at all. Watch out for these warning signs:

• Billing Medicare when you are not homebound

• Charging for services not ordered by your doctor

• Billing for services you never received

• Signing you up through a doctor you don’t know

• Offering “free” groceries, rides, or gifts in exchange for your Medicare number

• Asking you to sign incomplete or blank forms

• Billing for skilled nursing when only housekeeping was done​

 How to Protect Yourself

• Review Your Medicare Summary Notice (MSN) and Explanation of Benefits (EOB):
  Verify that services listed match what you received​.

• Work Only with Your Doctor:
  Don’t accept home health services arranged by strangers who call or visit uninvited.

• Say No to Gifts:
  Never accept money, groceries, or incentives in exchange for signing up for services.

• Don’t Sign What You Don’t Understand:
  Always review forms carefully before signing.

• Report Suspicious Activity Immediately:
  Early reporting can prevent bigger problems and protect others​.

📞 How to Report Suspected Home Health Care Fraud

If you believe you’ve been targeted:

📞 Call SMP Hawaii: 1-800-296-9422
📧 Email: info@smphawaii.org
🌐 Visit: www.smphawaii.org

We offer free, confidential support to help you navigate Medicare safely.

Stay alert. Stay informed. Stay protected.
Together, we can keep Hawaii’s kūpuna safe and strong!