Federal and state enforcement agencies are actively pursuing home health and hospice providers across Texas – and the cases below make clear that no provider type, market size, or dollar amount is beneath their notice.
Here are 10 recent enforcement actions, representing more than $36 million in civil settlements, three pending federal criminal cases and one home health agency owner already sentenced to federal prison.
#1. Home Health Company Pays $34 Million Over Unnecessary Services and Physician Kickbacks
In January 2026, Traditions Health LLC agreed to pay $34 million to resolve allegations that it submitted claims to Medicare for home health services that were not medically necessary and paid improper remuneration to medical directors in Texas and Oklahoma in exchange for patient referrals. The alleged conduct spanned three years and involved arrangements that prosecutors said potentially violated both the Anti-Kickback Statute and the Stark Law. Traditions self-disclosed the conduct, cooperated fully with investigators, and took remedial steps including removing responsible individuals and strengthening its compliance program – all factors the government credited in reaching the settlement.
Source: U.S. Department of Justice, Office of Public Affairs, January 22, 2026.
#2. $110 Million Hospice Fraud and Kickback Scheme in Fort Bend County
Federal prosecutors charged seven Houston-area residents in connection with United Palliative & Hospice Company (UPHC), a Richmond-based hospice operator accused of enrolling patients who were not terminally ill. According to the Department of Justice, Dera Ogudo and Victoria Martinez ran UPHC and allegedly paid kickbacks to group home owners for patient referrals and bribed a physician to falsely certify and re-certify patients as hospice-eligible. A hospital discharge coordinator allegedly received kickbacks for referrals as well.
After investigators searched UPHC's offices, Ogudo and Martinez allegedly opened two new hospice companies under straw owners to keep the scheme running, then laundered the Medicare reimbursements through a series of accounts. A superseding indictment in October 2025 added four more defendants, bringing the total to seven. The case is still pending; charges are accusations, not findings of guilt.
Source: U.S. Attorney's Office, Southern District of Texas, "Nearly 50 charged in Southern District of Texas as part of national health care fraud takedown," June 30, 2025, and "Four more charged in $110 million hospice fraud scheme," Oct. 21, 2025.
#3. Garland Hospice Owner Charged in $3.1 Million Scheme
As part of the 2026 National Health Care Fraud Takedown, prosecutors in the Northern District of Texas charged Catherine Maduka, owner and CEO of Saint Catherine's Hospice in Garland, with recruiting patients who did not qualify for hospice care and billing Medicare for services that were never provided. The indictment alleges more than $3.1 million in false claims. As with all pending charges, the allegations have not been proven in court.
Source: U.S. Attorney's Office, Northern District of Texas, "Northern District of Texas Charges 13 Health Care Fraudsters for Loss Over $360 Million," June 23, 2026.
#4. South Texas Home Health Provider Pays $1.7 Million Over Modifier Fraud
In December 2025, a South Texas home health provider agreed to pay $1,721,586 to resolve allegations that it billed the TD modifier – which provides additional reimbursement for services performed by a registered nurse rather than a licensed vocational nurse – without medical records to support the distinction. The provider's records also failed to support that some billed units were worked at all. When auditors find an unsupported modifier in a sample of your records, they extrapolate that finding to your entire recent claims history – and the math adds up fast.
Source: Texas Health and Human Services Office of Inspector General, Quarterly Report, Fiscal Year 2026, Quarter 2.
#5. Three Home Health Agencies Settle Over Services Never Rendered
Texas Health and Human Services Office of Inspector General (HHSC-OIG) resolved three separate cases involving home health providers in Dallas, McAllen, and Austin after investigations found that personal care attendants had billed Medicaid for bathing, feeding and dressing patients that never actually happened. The providers agreed to repay $11,303, $19,000 and $37,305, respectively, for a combined total of $67,608.
In each of these cases, the settlements were relatively small. That's exactly the point. Enforcement agencies like Texas HHSC-OIG, will pursue these cases regardless of scope or the potential for headline-grabbing settlements.
Source: Texas Health and Human Services Office of Inspector General, Quarterly Report, Fiscal Year 2026, Quarter 2
#6. El Paso Physician Pays $468,626 for Certifying Ineligible Hospice Patients
Dr. John Patterson, a physician practicing in El Paso, agreed to pay $468,626 to resolve allegations that he received kickbacks from a local hospice provider in exchange for certifying patients as eligible for hospice services – patients who, prosecutors alleged, did not actually meet the eligibility criteria. Under federal Medicare regulations, a physician's certification that a patient has a terminal prognosis of six months or less is required for Medicare hospice reimbursement. When that certification is purchased rather than clinically justified, every claim that follows is potentially fraudulent.
By falsely certifying patients, Dr. Patterson caused false claims to be submitted to federal healthcare programs, exposing him to False Claims Act liability independent of the hospice operator's own culpability.
Source: U.S. Attorney's Office, Western District of Texas, March 10, 2025
#7. Dallas Home Health Agency Pays $7,008 for Billing a Deceased Patient
In January 2025, a Dallas home health agency settled with HHSC-OIG for $7,008 after an OIG review of claims data and Medicaid client files found that the provider had submitted and received payment for attendant care services while the patient was in an inpatient facility – and continued billing after the patient died.
Source: Texas Health and Human Services Office of Inspector General, Quarterly Report, Fiscal Year 2025, Quarter 2
#8. Ventilator-Dependent Patient Billing Errors Cost Providers $171,909
HHSC-OIG settled with three separate Texas home health agencies – in Katy, Plano, and Sugar Land – after investigations found their medical records did not support use of the UA modifier, which provides additional Medicare reimbursement for patients who are ventilator-dependent or have a tracheostomy. In each case, a review of patient records showed the clients in question did not have a tracheostomy, were not ventilator-dependent, and did not have any of the eligible diagnosis codes. The three agencies paid $90,205, $33,020, and $48,684, respectively, for a combined total of $171,909.
These cases illustrate that enforcement agencies look for patterns to identify audit targets. HHSC-OIG's data analytics likely identified the UA modifier as a high-risk billing pattern, then queried claims across its entire provider population to find every agency billing that modifier – especially at elevated rates.
For providers in Texas, here’s the takeaway: If your billing patterns resemble those of an agency that has been audited or settled, you may already be under review.
Source: Texas Health and Human Services Office of Inspector General, Quarterly Report, Fiscal Year 2025, Quarter 1 and Quarter 3
#9. San Antonio Referral Source Faces Federal Indictment Over $9 Million in Hospice Fraud
Christina Charles, 52, of San Antonio, was charged by federal indictment with conspiracy to defraud the United States and to solicit and receive healthcare kickbacks in connection with a hospice fraud scheme. Prosecutors allege that Charles received illegal kickbacks in exchange for referring patients to multiple San Antonio-area hospice companies – and that those referrals caused the submission of more than $9 million in hospice claims that were ineligible for Medicare reimbursement because they were procured through bribes. Medicare paid approximately $3 million of those claims before the scheme was uncovered. This case is still an allegation, not a conviction – but it demonstrates that criminal liability in hospice fraud extends to referral sources, not just providers.
Source: U.S. Attorney's Office, Western District of Texas, “U.S. Attorney Announces Major Health Care Fraud Cases in Western District of Texas,” June 24, 2026.
#10. Home Health Agency Owner Sentenced to 75 Months for Forged Records
A Houston jury convicted Paul Njoku, owner of Opnet Health Care Services Inc. (doing business as P & P Health Care Services), on all counts for a scheme built on falsified medical records. Prosecutors showed that Njoku and others cut signatures from old documents and taped them onto newly created doctors' orders and nursing notes, and that Njoku kept using a registered nurse's signature for two years after she had left the company. A witness also testified that Njoku bribed a doctor to approve home health services. Njoku was sentenced to 75 months in federal prison.
Source: U.S. Attorney's Office, Southern District of Texas, "Home health agency owner sentenced to more than six years in Medicare fraud and identity theft scheme," Aug. 28, 2025.
A Pattern Worth Watching
Home health agencies were the single most common provider type in HHSC-OIG's preliminary Medicaid investigations for the most recent quarter on record, accounting for roughly a fifth of all cases opened. Combined with the federal government's focus on hospice and home health agency fraud, Texas providers should expect continued scrutiny from both state and federal regulators well into 2026.
Facing an Audit Notice or Records Request? Pay Attention to Deadlines!
Most healthcare investigations start with a records request from the Centers for Medicare & Medicaid Services (CMS) or one of their program integrity contractors. A medical records review can feel routine – just a request for ten or twenty charts – but buried in the fine print is a warning that missing the deadline (usually 30 days) means those services are automatically treated as non-verifiable.
From there, the consequences cascade quickly:
- An overpayment determination, which can then get extrapolated across your entire claims universe if it was based on a statistical sample
- A request to suspend your Medicare payments
- Potential revocation of your billing privileges
- And in the most serious cases, exclusion from federal healthcare programs entirely.
If your agency receives a medical records request, Civil Investigative Demand, or subpoena, or if you are contacted by an agent from a federal or state agency, contact legal counsel immediately. Our Texas-based healthcare investigations attorneys can step in right away to protect your rights and position your agency for the best possible outcome.
