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Commonwealth of VirginiaOffice of the Attorney General

Jason S. MiyaresAttorney General

202 North 9th StreetRichmond, Virginia 23219804-786-2071FAX 804-786-1991Virginia Relay Service800-828-1120

For media inquiries only, contact:Victoria LaCivita(804) 588-2021This email address is being protected from spambots. You need JavaScript enabled to view it.

1st Adult & Pediatrics Healthcare to Pay $3 Million to Settle False Claims Act Allegations

LYNCHBURG, Va. 1st Adult & Pediatrics Healthcare Services, headquartered in Fairfax, Virginia, has agreed to pay $3,000,000 to resolve allegations that it violated the False Claims Act by engaging in fraudulent billing activities between January 2017 and May 2021 with regards to pediatric in-home health, personal care, and related services.

From 2017 and continuing through May 2021, 1st Adult & Pediatrics billed Virginia Medicaid for reimbursements for in-home health care services for pediatric patients who were actually hospitalized at the time the in-home services were billed. In addition, 1st Adult & Pediatrics routinely billed Virginian Medicaid for home health services that were not actually provided.

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 Virginia Attorney General Jason Miyares.

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 today. 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.

Providers that submit false Medicaid claims disregard their legal requirement to bill for services legitimately and, simultaneously, cheat the program on which their patients greatly rely, stated Special Agent in Charge Maureen R. Dixon of the Department of Health and Human Services Office of Inspector General (HHS-OIG). In collaboration with fellow agencies, HHS-OIG is committed to preventing and detecting fraud in taxpayer-funded health care programs.

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. 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 whistleblowers case and obtained default prior to settlement. The case is captioned U.S. ex rel. Patterson & Williams v. 1st Adult & Pediatrics Healthcare Services, Inc., Civil Action No. 6:19-cv-68.

The resolutions obtained in this matter were the result of a coordinated effort among the United States Attorneys Office for the Western District of Virginia, the Office of the Virginia Attorney Generals Medicaid 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 matter.

The claims resolved by the settlement are allegations only and there has been no determination of liability.

The Medicaid Fraud Control Unit is funded 75% by a grant from the Department of Health and Human Services, Office of the Inspector General, with 25% matching funds from the Commonwealth of Virginia.

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Original post:
April 19, 2023 - 1st Adult & Pediatrics Healthcare to Pay $3 Million to ... - Attorney General of Virginia