WASHINGTON, D.C. – Attorney General Karl A. Racine today announced a lawsuit against Vizion One, a home health care provider, for defrauding the District’s Medicaid program of more than $3 million. In the lawsuit, the Office of the Attorney General (OAG) alleges that Vizion One engaged in an elaborate scheme to profit by submitting false Medicaid claims for at-home care that was not medically necessary, properly authorized, or actually provided. As part of this scheme, Vizion One employees recruited Medicaid recipients—including by canvassing outside of homeless shelters and District social service agencies—and bribed them to falsely claim they needed care that was not actually necessary or provided to them. Vizion One also paid kickbacks to chiropractors who signed fraudulent treatment plans for submission to the District’s Medicaid Program for reimbursement. With this lawsuit, the District is seeking to recover more than $3 million in Medicaid funds paid to Vizion One because of the company’s fraudulent claims.
“Vizion One cheated District taxpayers and stole millions of dollars in Medicaid funds that should have gone towards needed medical care for vulnerable members of our community, including disabled seniors, children from low-income families, and pregnant women,” said AG Racine. “The Office of the Attorney General will not hesitate to sue companies that unjustly enrich themselves at the expense of taxpayers and vulnerable District residents.”
The District’s Medicaid program reimburses personal care services for Medicaid beneficiaries who are disabled or have conditions that render them homebound. The services allow these people to remain in a home setting and avoid long-term in-patient stays in hospitals and nursing homes. To receive personal care services paid for by Medicaid, beneficiaries must obtain a prescription from a doctor or a nurse practitioner who has examined them and determined that they need assistance with one or more activities of daily life, including getting out of bed, bathing, dressing, eating, taking medication, or using the bathroom.
In this lawsuit, OAG alleges that Vizion One, an agency that employed personal care aides, unjustly enriched itself from 2012 through 2014 by submitting false claims for services that were not authorized or never provided. Specifically, Vizion One:
- Bribed Medicaid recipients to falsely claim they needed services: Vizion One recruited Medicaid beneficiaries willing to engage in their scheme by canvassing outside of homeless shelters, medical clinics, and District agency offices, including the Department of Human Services processing centers and the Department on Disability Services’ offices. They offered Medicaid beneficiaries cash payments to falsely claim they needed at-home personal care services. If a beneficiary agreed to participate in the scheme, Vizion One employees or agents assisted in getting that individual approved for services, including by coaching them to lie to medical professionals about their health and by providing fake District addresses to people who lived outside of the District.
- Paid kickbacks to chiropractors to fraudulently prescribe care: Vizion One recruited chiropractors who were not medically or legally qualified to prescribe personal care services to write prescriptions for these services to Medicaid beneficiaries. Vizion One gave the chiropractors examples of pre-filled exam forms so they understood what to write to qualify individuals for services. Vizion One paid up to approximately $200 to chiropractors for each prescription.
- Charged the District for services that were never provided: After beneficiaries obtained their fraudulent prescriptions for at-home care, Vizion One would not provide those services. Instead, a Vizion One employee would pay the beneficiary up to $200 every two weeks to sign time sheets falsely stating they received requested care. The Medicaid beneficiaries involved in this scheme typically received prescriptions for care that resulted in the District’s Medicaid Program paying Vizion One between $16,952 and $23,732 for each one.
With this lawsuit, OAG is seeking to recover more than $3 million in Medicaid funds it paid to Vizion One because of the company’s fraudulent claims, as well as interest and costs the District incurred by bringing this case.
A copy of the complaint is available at: https://oag.dc.gov/sites/default/files/2021-03/Vizion-One-Complaint.pdf
When OAG receives an allegation of Medicaid fraud from the Office of Inspector General’s Medicaid Fraud Control Unit, the office independently reviews the case to determine whether legal action is appropriate.
“My office is happy to have investigated and referred this case to the Attorney General’s Office. We will not sit idle while the District is defrauded,” said Inspector General Daniel W. Lucas. “The OIG’s Medicaid Fraud Control Unit is dedicated to investigating these cases of fraud and bringing them to a criminal or civil resolution to ensure the District’s Medicaid program can continue to assist those most in need.”
Report Medicaid Fraud in the District
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.