A Gastonia-based home healthcare agency and its owner have agreed to collectively pay $600,000 to resolve allegations that the company submitted thousands of fraudulent Medicaid claims, according to the U.S. Attorney’s Office.
Family First Home Home Care, now doing business as Gaston Piedmont Health Care, and its owner, Marion James, billed Medicaid for personal care services that were never performed from Jan. 1, 2015, to Jan. 9, 2020, according to the U.S. Attorney’s Office in Charlotte. Some of those bills for in-home services came on days when patients were hospitalized.
Other services purportedly provided to patients in their homes by James’ daughter came 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, according to the U.S. Attorney’s Office.
The government also alleges Family First and James engaged in a scheme to have family member aides provide personal care services to other 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.
Marion James returned a call from Business North Carolina. When asked about the allegations, she says she did nothing wrong but declined to discuss details, instead asking if she could call back. Gaston Piedmont Health Care provides services to several counties. The government claims James and her company defrauded the government healthcare system.
“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,” says U.S. Attorney Dena King in a statement.
“These defendants stole hundreds of thousands of taxpayer dollars while never actually providing the care they claimed to,” says N.C. Attorney General Josh Stein in a statement released by the U.S. Attorney’s Office.
The civil settlement includes the resolution of claims brought under the 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 claims resolved by the settlement are allegations. There has been no determination of liability, according to the U.S. Attorney’s Office.