Healthcare provider agrees to $3 million false claims settlement

Posted at 10:40 PM, Jul 06, 2018
and last updated 2018-07-06 22:40:27-04

RICHMOND, Va. – Hope In-Home Care, LLC (Hope), a Newport News-based provider of Medicaid in-home healthcare services, agreed to settle allegations that it submitted false claims to the Virginia Medicaid Program.

Under the terms of the settlement Hope will pay a total of $3,345,065.35 to the United States and Virginia.

The U.S. Attorney’s Office and the Virginia Attorney General’s Office alleged multiple fraudulent schemes by Hope covering almost a three-year period from January 2011 thru September 2013, including:

  1. Hope employed and submitted claims for uncertified “personal care aides” who were ineligible to provide services.
  2. Hope falsified documents and statements in order to qualify ineligible beneficiaries for services.
  3. Hope made false statements in prior authorization requests in order to obtain approval and reimbursement for non-reimbursable “respite services.”
  4. Hope engaged in “phantom billing” by billing for services that were not performed.
  5. Hope hired family members of Medicaid beneficiaries as “personal care aides” and submitted ineligible claims for compensation for care provided by those family members.

Hope operates facilities in the Newport News–Williamsburg I-64 corridor, Virginia Beach and Warrenton, as well as Gloucester, King William, King and Queen and Culpeper Counties.

The resolution in this matter was the result of a coordinated effort between the U.S. Attorney’s Office for the Eastern District of Virginia and the Office of the Attorney General for the Commonwealth of Virginia Medicaid Fraud Control Unit, with support from the Virginia Department of Medical Assistance Services.

The civil claims settled by this False Claims Act agreement are allegations only, and there has been no determination of civil liability.