Virginia healthcare company to pay $3 million to settle false Medicare claims

A healthcare services company headquartered in Fairfax will pay $3 million to resolved allegations that it violated the False Claim Acts by engaging in fraudulent billing activities for more than four years.

The company, 1st Adult & Pediatrics Healthcare Services, allegedly billed Virginia Medicaid for reimbursements for in-home health care services for pediatric patients who were hospitalized at the time they billed for services. Also, the Department of Justice alleges that the company routinely billed Virginia Medicaid for home-health services that were not provided. The fraudulent billing activities allegedly took place from January 2017 to May 2021.

“The Medicaid and Medicare systems are important safety nets for many in our communities, especially vulnerable patients, like the seriously ill children involved in this case. We must do our part to keep them free of waste, fraud and abuse,” Principal Deputy United States Attorney Zachary T. Lee said. “I am grateful for our partnership with the Virginia Medicare Fraud Control Unit and the Department of Health and Human Services in resolving this matter.”

Virginia Attorney General Jason Miyares was pleased with the work done by his office and federal partners.

“Those who take advantage of Virginians during some of their most vulnerable times must be held accountable. Thanks to the excellent work done by my office and our federal partners, this organization will have to answer for its illegitimate billing methods that exploited hospitalized pediatric patients,” said Miyares.

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act against 1st Adult & Pediatrics, according to the Department of Justice. Under the qui tam provisions of the False Claims Act, a private party can file an action on behalf of the United States and receive a portion of the settlement if the government takes over the case and reaches a monetary agreement with the defendant. In this case, the United States and Commonwealth of Virginia intervened in the whistleblower’s case and obtained default prior to settlement.

The resolutions obtained in this matter were the result of a coordinated effort among the United States Attorney’s Office for the Western District of Virginia, the Office of the Virginia Attorney General’s Medicare Fraud Control Unit and the Department of Health and Human Services. Assistant U.S. Attorney Justin Lugar and the Affirmative Civil Enforcement Division investigated the alleged fraud.