WASHINGTON, D. C. – Attorney General Karl A. Racine today announced that he has filed a False Claims Act lawsuit against Deborah Kale, a personal care aide, for allegedly committing Medicaid fraud. The suit alleges that Kale submitted a phony time sheet to Health Management Incorporated (Health Management), causing the company to bill the District’s Medicaid program for home health aide services that Kale did not perform.
“Those who exploit the Medicaid system for personal gain are taking services away from those who need them the most,” said Attorney General Racine. “We will continue to aggressively pursue caregivers who steal from Medicaid.”
The lawsuit was brought under the District’s False Claims Act, which provides for a recovery of triple damages plus civil penalties if the District proves its allegations. In this case, the District lost $783.36 in taxpayer funds to the alleged fraud, and the suit requests damages of $2,350.08 and a civil penalty of up to $11,000. The Attorney General alleges that Kale fabricated a time sheet indicating she provided 94 hours of services to a Medicaid recipient, when, in fact, she was on a cruise in the Bahamas.
The District’s Medicaid program reimburses personal care services provided by aides to Medicaid beneficiaries in their homes when the beneficiaries are disabled or have chronic or temporary conditions rendering them homebound. The services are designed to enable individuals to remain in a home setting and avoid long-term in-patient stays in hospitals and nursing homes.
The Medicaid Program Integrity Division within the District’s Department of Health Care Finance (DHCF) provides oversight of the District’s Medicaid program. The principal function of the Program Integrity Division is to reduce and eliminate fraud, waste, and abuse in the Medicaid Program. This includes prevention, investigation, education, audits, recovery of improper payments, and cooperation with the District’s Medicaid Fraud Control Unit and other federal and local law enforcement agencies.
“Individuals or health care company employees who suspect fraud against the District’s Medicaid program can make an anonymous report to www.dhcf.dc.gov/page/reporting-fraud-waste-and-abuse-01 or by calling (877) 632-2873,” said DHCF Medicaid Director Claudia Schlosberg.
Attorney General Racine and Director Schlosberg thanked the District’s Medicaid Fraud Control Unit, part of the District’s Office of Inspector General (OIG), for investigating this case. OIG then referred the case to the Office of the Attorney General for further action.