PHILADELPHIA, PA — Blessings 4 Ever Home Care Agency LLC and affiliated management company V&V Management Solutions LLC have agreed to pay $1 million to resolve civil allegations that they improperly billed Pennsylvania’s Medicaid program using falsified employee records and sought reimbursement for in-home care services provided while patients were hospitalized, federal prosecutors said Tuesday.
The settlement resolves allegations under the False Claims Act stemming from two separate billing practices that the United States contends resulted in false Medicaid claims. The companies did not admit liability as part of the civil resolution.
According to the U.S. Attorney’s Office for the Eastern District of Pennsylvania, Blessings submitted or caused claims to be submitted for reimbursement using personal care attendants whose personnel files contained falsified or backdated documentation intended to demonstrate compliance with state training and Medicaid program requirements.
Federal investigators alleged that between January 2015 and December 2018, the company fabricated or backdated 181 training certificates and personnel records to certify that personal care attendants met qualifications required to provide in-home services to Medicaid beneficiaries.
Prosecutors also alleged that from June 2020 through December 2023, Blessings improperly billed Medicaid for 1,141 claims covering in-home personal care services on days when 209 beneficiaries were hospitalized for the entire day and receiving inpatient medical care already covered under Medicare and Medicaid.
The allegations centered on documentation and billing practices that the government contends resulted in false claims submitted to the Medicaid program.
“In-home care agencies have a responsibility to ensure that only qualified personnel care for Medicaid beneficiaries in their homes,” U.S. Attorney David Metcalf said. “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.”
Maureen Dixon, special agent in charge of the U.S. Department of Health and Human Services Office of Inspector General, said the agency would continue pursuing Medicaid fraud involving patient care and billing practices.
“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,” Dixon said.
The settlement also resolves claims brought under the False Claims Act’s whistleblower provisions in United States ex rel. Fatima Precia v. Blessings 4 Ever Home Care Agency LLC and V&V Management Solutions LLC (Civil Action No. 18-cv-901). Under the agreement, the whistleblower will receive 21% of the federal recovery.
The investigation was conducted by the U.S. Department of Health and Human Services Office of Inspector General. Assistant U.S. Attorneys Viveca D. Parker, Lauren DeBruicker and Deputy Chief Charlene Keller Fullmer handled the matter for the government.
Support the local news that supports Chester County. MyChesCo delivers reliable, fact-based reporting and essential community resources—free for everyone. If you value that, click here to become a patron today.