It was alleged the home health agency violated the False Claims Act by submitting fraudulent claims to Medicaid for reimbursement

CHARLOTTE, North Carolina—Family First Home Health Care, Inc. (Family First), a home health care agency located in Gastonia, North Carolina, (now d/b/a Gaston Piedmont Health Care Inc.), and its owner Marion James have agreed to collectively pay $600,000 to resolve allegations that they knowingly violated the Federal and North Carolina False Claims Acts from Jan. 1, 2015, through Jan. 9, 2020, by submitting thousands of fraudulent claims to Medicaid for reimbursement, announced Dena J. King, U.S. attorney for the Western District of North Carolina.

Specifically, the United States and State of North Carolina (the Governments) alleged that Family First and James billed Medicaid for personal care services that were never performed, such as billing for in-home services on days when patients were hospitalized. Similarly, the Governments alleged that Family First and James billed for years of personal care services purportedly provided to patients in their homes by James’ daughter while she was hours away at college as a full-time student playing on the varsity basketball team, or billed for services provided by an aide after that aide had moved out of state.

The Governments further alleged that Family First and James engaged in a scheme to have family member aides provide personal care services to their own family member beneficiaries (for example, a daughter providing services to her mother) in violation of state Medicaid regulations, and then fraudulently bill for those services as if they were performed by a non-related aide, forging documents and signatures to perpetuate the scheme.

“Medicaid beneficiaries qualifying for personal care services are those that require assistance with daily living tasks, often the elderly. This settlement demonstrates that those who would profit from defrauding government healthcare payors while taking advantage of vulnerable patients entrusted to their care will be held accountable,” said King.

“Submitting false claims to Medicaid undermines the integrity of the program and wastes valuable taxpayer dollars,” said Special Agent in Charge Tamala E. Miles at the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “Working closely with our law enforcement partners, HHS-OIG remains committed to investigating providers who allegedly defraud federal health care programs.”

“These defendants stole hundreds of thousands of taxpayer dollars while never actually providing the care they claimed to,” said North Carolina Attorney General Josh Stein. “My office will hold accountable those who defraud the Medicaid system and take away resources from people who need them.”

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by former Family First employee Heather Coleman. Under those provisions, a private party may file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned U.S. ex rel. Coleman v. Family First Home Health Care, LLC and Marion James, No. 3:19-CV-405 (W.D.N.C.). The settlement amount was based on Family First and James’ ability to pay.

The claims resolved by the settlement are allegations only. There has been no determination of liability.