Philadelphia In-Home Care Services Provider Agrees to Pay $1 Million to Resolve Allegations of False Claims Act Violations

PHILADELPHIA - United States Attorney David Metcalf announced today that Blessings 4 Ever Home Care Agency LLC and V&V Management Solutions LLC ("Blessings") have agreed to a $1 million resolution of civil claims arising from improperly submitting claims for payment from the Medicaid Program for services provided by personal care attendants ("PCAs") using falsified documentation, and for the improper billing of claims for in-home personal care services for beneficiaries that were hospital inpatients.

Blessings provides in-home health, personal care, and related services to Pennsylvania Medicaid beneficiaries, and bills the Medicaid Program for such services. V&V, a related entity, provides management services to Blessings. The United States contends that Blessings 4 Ever submitted or caused to be submitted claims for payment to the Medicaid Program for services provided by PCAs using falsified documentation, resulting in false claims in violation of the False Claims Act.

The United States alleges that from January 2015 to December 2018, Blessings 4 Ever fabricated or backdated 181 training certificates and personnel documents to falsely certify that PCAs satisfied state training requirements and Medicaid Program requirements to provide services inside beneficiaries' homes. In falsifying their files and using records fabricated to meet program requirements, Blessings 4 Ever allegedly operated its home care agency using certain PCAs who lacked the proper documentation in place to perform the services that were being billed by Blessings 4 Ever, thereby providing substandard services to the detriment of consumers and the Medicaid waiver program.

The United States further alleges that from June 2020 through December 2023, Blessings 4 Ever improperly billed Medicaid for 1,141 claims for in-home personal care services on days when the claimed 209 beneficiaries were hospital inpatients for the entire day receiving medical care payable under the Medicare and Medicaid programs.

"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 includes the resolution of claims brought by a relator under the qui tam or whistleblower provisions of the False Claims Act. Under the act, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States ex rel. Fatima Precia v. Blessings 4 Ever Home Care Agency LLC and V&V Management Solutions LLC, Civil Action 18-cv-901. Relator will receive a 21% share of the federal recovery.

This investigation was conducted by Special Agents with the U.S. Department of Health and Human Services Office of Inspector General. Assistant United States Attorneys Viveca D. Parker, Lauren DeBruicker, and Deputy Chief Charlene Keller Fullmer handled the investigation and resolution, with former auditor George Niedzwicki and paralegal Brendan Novak.