October 24, 2011
Jefferson City, Mo.— Attorney General Chris Koster today announced a settlement with Delmar Gardens Private Services (DGPS), a Chesterfield, Missouri, company that arranges for the provision of in-home personal care services for qualified individuals. The settlement resolves allegations that DGPS submitted claims to Medicaid for in-home health services that were not eligible for reimbursement under Medicaid rules and state regulations.
The Attorney General’s Medicaid Fraud Control Unit alleges that DGPS submitted claims to Medicaid for reimbursement for in-home services provided by in-home service workers to immediate family members when such workers were ineligible to provide such services. Additionally, DGPS submitted a limited number of claims to Medicaid for reimbursement when in-home services could not have been provided because the clients were admitted to a hospital or nursing home, or the DGPS employee was working at another place of employment. After the MFCU began its investigation, DGPS fully cooperated in efforts to identify any additional inappropriate billings by performing an extensive internal audit.
The settlement required DGPS to pay $579,920 in restitution and civil penalties, and $7,500 in investigative costs. DGPS also agreed to implement various quality assurance measures, such as mandatory employee training and enforcement of internal policies.
“Medicaid pays companies like Delmar Gardens to ensure Medicaid in-home services are delivered appropriately, and it is the responsibility of this office to make sure the companies follow the law.” Koster said. “From the outset of the investigation, Delmar Gardens fully cooperated with this office and took steps to make sure they are in full compliance in the future.”
Koster said citizens should report suspected Medicaid provider fraud or abuse and neglect to his Medicaid Fraud Hotline toll free at 800-286-3932, e-mail the complaint to firstname.lastname@example.org or complete a complaint form at the Attorney General’s Medicaid Fraud Website at http://ago.mo.gov/divisions/medicaid-fraud-control-unit-faqs.htm.