NEWPORT NEWS — A health care provider here has settled a false claims lawsuit in federal court and will pay a total of $3.35 million to the United States and Virginia.
Hope In-Home Care LLC was accused of “multiple fraudulent schemes” from January 2011 to September 2013, including employing uncertified staff and falsifying documents, according to a news release from the U.S. Department of Justice Monday.
Hope In-Home Care operates Medicaid-funded facilities on the Peninsula, and in Virginia Beach, Warrenton, and Gloucester, King William, King and Queen, and Culpeper counties.
Hope employed and submitted claims for uncertified “personal care aides” who weren’t able to provide services, falsified documents and statements to qualify ineligible beneficiaries for services, and made false statements to gain approval and reimbursement for non-reimbursable “respite services,” according to the news release.
The Justice Department also said Hope billed for services that hadn’t been performed and hired family members of Medicaid beneficiaries and submitted claims for their work.
The claims settled under the agreement are “allegations only,” the Justice Department said, meaning a judge has not made a determination regarding civil liability.
The civil case that was settled also has a related criminal case in federal court for the Eastern District of Virginia. The allegations are similar in nature to the ones in the civil case.
The criminal case was filed against Linda G. Box, Hope’s administrator/director, and was closed in June 2017 after Box pleaded guilty to health care fraud.
Box was sentenced to 24 months of home detention.
According to court papers, Box regularly completed initial assessments for recipients of Medicaid and used them to develop plans of care. She also exaggerated and fabricated Medicaid recipients’ needs on the forms so they could qualify for funding, and hired their family members to care for them.
On one patient’s chart, Box lied and said a woman needed extensive help with daily living activities and walking. Box also reported the woman’s husband was not able to meet her daily needs.
Medicaid funding was based on that assessment, although the woman was able to walk and clean her house without assistance. Because of the false assessment, Hope In-Home Care billed Medicaid more than $3,000 extra.
Another patient’s mother was hired to care for him, resulting in more than $140,000 in misused Medicaid funding, the Justice Department said.
