United Home Healthcare and B&L: Unworked and Undocumented Medicaid Hours

United Home Healthcare and B&L agreed to a combined $1.5 million home health settlement over allegations that the companies billed Medicaid for undocumented personal and attendant care, services not provided on billed dates, and more hours than patients received. According to investigators, the patient files and the bills told different stories.

The Justice Department announced the civil False Claims Act settlement on June 29, 2015. It named United Home Healthcare, Inc. and B&L Personal Services, Inc., both based in Indianapolis, with the same owners running both businesses. The companies provided personal and attendant care throughout Central Indiana. The government alleged a pattern of overbilling from 2012 through 2014.

What the Patient Files and Bills Showed

The government’s allegations came from comparing patient files with corresponding billing data. Investigators also interviewed patients and former employees. The Department of Health and Human Services Office of Inspector General and the Indiana Attorney General’s Medicaid Fraud Control Unit began investigating a complaint in 2012 that the companies were billing for services they had not provided.

Billed Care Without Documentation

The government alleged that many billed personal-care and attendant-care services lacked documentation in the patient files. For an insider, the useful connection is specific: the patient, the date, the service and the bill. We want to understand what the care file was supposed to contain, who completed it, and how that information reached billing.

Paid Dates With No Service in the File

The government also alleged that Medicaid reimbursed the companies for dates when the patient file showed the patient had not received the service. Here the alleged conflict was direct. A paid bill said care occurred, while the file said it did not.

More Hours Billed Than Delivered

The remaining allegation concerned the amount of care: the companies allegedly billed more service hours than they actually provided. An insider may recognize this problem in the difference between time worked and time charged, even when a visit did take place.

In the government’s account, the extra care existed only on the bill. We call that charging taxpayers for hours nobody worked.

Medicaid Personal Care Runs From Authorization to Payment

Medicaid personal-care billing connects authorized assistance, the attendant who provides it, the time worked and the claim for payment. The Medicare home health certification chain centers on eligibility, skilled need, the encounter and the plan of care. Medicaid personal care has its own authorization and payment arrangements. For personal care under a Medicaid state plan, a treatment plan or state-approved service plan authorizes the care, and a qualified worker provides it.

The authorization, time records and paid claim follow the same care through different hands. An attendant knows the work in the home; the billing office sees the units charged. We connect those accounts with the person who knows where they diverged.

Worker identity matters too. The separate issue of home health aide qualifications concerns who was entitled to provide the service. HHS’s Office of Inspector General identified attendant identity, qualifications, task authorization and delivery documentation as recurring weaknesses in its personal-care oversight work.

The same distinction applies to the reason for care. Unnecessary home health care concerns services billed despite a lack of medical need. The United and B&L allegations focused on documentation, whether services occurred and how many hours were delivered. Keeping those questions separate helps us aim a case at the discrepancy an insider actually saw.

The Settlement Compared With the Medicaid Loss

The companies agreed to pay the United States more than twice the estimated Medicaid loss. The Justice Department put that loss at $589,043 across thousands of individual claims, against a federal payment of $1,454,490.

The companies also agreed to pay Indiana $45,510 for investigative fees and costs. That cost payment formed part of the combined settlement, separately from the estimated Medicaid loss.

Attendance Controls and Unprovided Services

Home Family Care faced a similar allegation about Medicaid paying for care that was never delivered. In its settlement announcement, the Justice Department alleged that the provider deliberately bypassed aide-attendance verification and internal controls, allowing claims for unprovided home health aide and personal-care services. That case arose from a qui tam complaint.

The connection is the service behind the claim. In Home Family Care’s case, the alleged breakdown involved attendance controls. In United and B&L’s case, investigators described discrepancies between patient files, services provided and billing data. Both accounts show why the people who understand the attendance and care records can matter to a Medicaid billing case.

What Evidence Is Needed to Prove Fraud?

For allegations about Medicaid care hours, the evidence connects the service authorized, the work performed, the hours billed and the resulting payment. We examine that connection with the insider who can explain the records and the decisions behind them.

A care file gives the account of the service. A time record adds duration. A bill shows what the agency charged. We follow the same patient and date through those records, with the authorization alongside them. Instructions, corrections and approvals help us understand who knew about a discrepancy and what happened after it appeared.

For present-day Medicaid care, electronic visit verification adds the worker, location and start and end times to that comparison. We examine visit records alongside the authorized care and billed units to understand how the agency turned time in the home into a claim.

An attendant may know the work performed, while a scheduler or biller may understand how the hours moved through the agency. We bring that operational knowledge into the case assessment. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know the Hours Behind the Claim

If the hours you worked, scheduled or reviewed differ from the hours your agency billed, talk with our whistleblower experts about what you saw. We work alongside you to connect the care, the claims and the decisions inside the agency, and bring in Medicaid fraud whistleblower lawyers who understand personal-care billing. From the first conversation through the case, you have experts on your side who understand why that difference matters.