Blessings 4 Ever Home Care Agency LLC and V&V Management Solutions LLC have agreed to pay $1 million to resolve civil claims related to improper billing practices, according to an Aug. 4 announcement from United States Attorney David Metcalf. The settlement addresses allegations that the agencies submitted false claims for payment from the Medicaid Program by using falsified documentation and billing for services provided while beneficiaries were hospital inpatients.
Blessings provides in-home health and personal care services to Pennsylvania Medicaid beneficiaries, with V&V offering management support. The United States alleges that between January 2015 and December 2018, Blessings fabricated or backdated 181 training certificates and personnel documents, falsely certifying that personal care attendants met state training requirements. This allegedly enabled the agency to bill for services performed by staff who lacked proper qualifications.
Further allegations state that from June 2020 through December 2023, Blessings improperly billed Medicaid for 1,141 claims on days when the claimed beneficiaries were hospitalized as inpatients receiving medical care covered by Medicare or Medicaid.
“In-home care agencies have a responsibility to ensure that only qualified personnel care for Medicaid beneficiaries in their homes. They must not only properly document the training and qualifications of those providing services for Medicaid reimbursement, but must also ensure that qualified personnel are in fact providing the services billed,” said U.S. Attorney Metcalf.
“HHS-OIG remains dedicated to combating Medicaid fraud by ensuring only qualified and trained individuals take care of the vulnerable populations it serves and that Medicaid is only billed appropriately for services that were actually provided,” said Maureen Dixon, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General. “HHS‑OIG and our law enforcement partners will continue to hold those who put profits above patients accountable for their actions.”
The civil settlement resolves claims brought under whistleblower provisions of the False Claims Act by relator Fatima Precia; she will receive a 21 percent share of the federal recovery. The investigation was conducted by agents with HHS-OIG, along with Assistant United States Attorneys Viveca D. Parker, Lauren DeBruicker, Deputy Chief Charlene Keller Fullmer, former auditor George Niedzwicki, and paralegal Brendan Novak.