March 19, 2024. North Carolina-based home healthcare agency, Family First Home Health Care, Inc. (Family First), and its owner, Marion James, have agreed to pay $600,000 to settle claims that they intentionally submitted false claims to Medicaid for reimbursement. A whistleblower who alerted both the United States and North Carolina to the False Claims Act violations will be rewarded for providing the information that led to the suit.
From January 2015 to January 2020, Family First, led by James, submitted thousands of false claims to Medicaid to receive reimbursement for services that either never occurred or were incorrectly billed. Family First and James billed for services performed at patients’ homes despite those patients being in the hospital at the time the services were allegedly performed. They also billed for personal care services provided by James’ daughter while she was actively hours away at college and playing on the varsity basketball team. Similarly, Family First and James also billed Medicaid for services performed by an aide despite that aide not living in the state at the time. Furthermore, Family First and James violated state Medicaid regulations by having family member employees provide care to their relatives, then falsified and forged documents to cover the scheme up.
The U.S. Attorney for the Western District of North Carolina warned fraudsters: “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.” Home healthcare is meant to work with Medicaid to provide medically necessary care to beneficiaries, while allowing them to remain in private residences. Fraudulent practices damage the integrity of these programs and put patients at risk.
The settlement was brought about thanks to Heather Coleman, a former employee of Family First, who blew the whistle, filing suit under the qui tam provisions of the False Claim Act. Her reward has not been disclosed, but whistleblowers are entitled to 15-25% of the government’s recovery in a qui tam False Claims Act settlement.
If you would like to report healthcare (Medicare, Medicaid, TRICARE) fraud or home healthcare fraud, you can contact attorneys at Tycko & Zavareei LLP. Eva Gunasekera and Renée Brooker are former officials of the United States Department of Justice and prosecuted whistleblower cases under the False Claims Act. Renée served as Assistant Director at the United States Department of Justice, the office that supervises False Claims Act cases in all 94 United States District Courts. Eva was the Senior Counsel for Health Care Fraud. Eva and Renée now represent whistleblowers. For a free consultation, you can contact Renée at [email protected] (tel.: 202-417-3664) or contact Eva Gunasekera at [email protected]. You can also go to Tycko & Zavareei LLP’s website for whistleblowers to learn more at www.fraudfighters.net.