Compassionate Home Care Services Inc., a North Carolina health care company, has lost a False Claims Act lawsuit claiming the company knowingly submitted over 1,000 false claims to Medicaid. A judge determined that they must pay a total of $2.2 million in Medicaid fraud penaltiesfor violations of federal and North Carolina False Claims Acts.

Chief U.S. District Judge C. Dever ruled in the government’s favor on Monday, determining that Compassionate Home Care Service as well as the company’s owner, Carol Anders, and the owner’s son, Ryan Santiago, had submitted fraudulent Medicaid claims and receiving funds as a result. Dever determined that the federal and North Carolina state governments will receive a civil penalty from the company.

Medicaid Fraud Penalties

Judge Dever stated that the jury for the Compassionate fraud lawsuit had discovered a total of 1,060 false Medicaid claims by the company. However, the government only seeks to hold the three parties liable for 158 violations. As a result, Compassionate Health Care and Anders will pay the minimum civil penalty of $5,500 for each of the 158 violations, with Medicaid fraud penalties totaling $869,000.

Santiago, Anders’s son, also worked as an employee of the heath care company. The jury found him responsible for a “knowing creation or use of false time sheets to fill gaps in Compassionate’s files,” as was Anders herself. The damages that were done as a result of his involvement were determined to be $111,918 in value, and combined with the violations done by the company itself and the company’s owner total $335,753.

Allegedly, Compassionate Home Care was founded as a Medicaid provider in 2003. Anders handled the company’s daily operations, which included Medicaid billings. This work was done with Anders’ husband and co-owner of the company, Anthony Anders, who left North Caroline in 2012. After his departure, Carol Anders assumed full control over the company’s operations.

A complaint was filed in May 2014 against the company, alleging that it had falsified Medicaid claims. According to this complaint, Anders is a registered nurse, and, under this capacity, was required to routinely check that patients receiving Medicaid care are receiving the services for which they are being billed, and determine if their need for care remains constant or requires a change. This is required by Medicaid’s policy, according to the complaint.

However, the complaint alleges that Anders filled out time sheets as if she were performing the routine checks, but may of those time sheets were fraudulent. This practice allegedly allowed them to receive funds for services not provided, and help hide earlier falsified billings and claims.

In June 2018, a jury discovered that Anders and the company had submitted 224 false Medicaid claims to the North Carolina Medicaid Program. As a result, they received $260,621. The jury also found that they had produced 836 falsified documents and that Medicaid allegedly paid $174,175 based on the information in those documents.

The Compassionate Home Care Services Inc. Medicaid Fraud Lawsuit is Case No. 7:14-cv-00113, in the U.S. District Court for the Eastern District of North Carolina.