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WASHINGTON – Total Care Services and its owner have agreed to pay $187,500 to resolve allegations that they violated the False Claims Act by knowingly billing Medicaid for patient services for which they had no, insufficient, or inaccurate documentation.
The settlement, signed Jan. 2, 2014, was announced by U.S. Attorney Ronald C. Machen Jr., Irvin B. Nathan, Attorney General for the District of Columbia, and Charles J. Willoughby, Inspector General for the District of Columbia. The agreement calls for $131,250 to be paid to the United States and for $56,250 to be paid to the District of Columbia.
Total Care Services, a non-profit company based in Northeast Washington, is a Medicaid provider under the District of Columbia’s Medicaid program. Drucella Wheeler Ndoye is the company’s owner, chief executive officer, and president.
Under the Medicaid program, the company provides services to individuals with cognitive and developmental disabilities. Such services include adult companion services, respite care, nutrition services, and speech, hearing and language services.
Total Care Services has a provider agreement with the District of Columbia. The agreement requires the company to maintain all relevant records for a period of six years or until audits are completed, whichever is longer. Such records include all documents originated or prepared pursuant to performance under the provider agreement. These include, for example, financial records, medical records, charts and other documents pertaining to costs, payments received and made, and services provided to Medicaid recipients.
The settlement agreement resolves allegations that Total Care Services and Ndoye billed the District of Columbia Medicaid program for patient services over a significant period knowing that they did not have adequate documentation for doing so. The agreement is neither an admission of liability by the company or Ndoye nor a concession by the United States that the claims are not well-founded. The parties agreed to resolve the matters without litigation.
In announcing the agreement, U.S. Attorney Machen, Attorney General Nathan, and Inspector General Willoughby commended the efforts of those who worked on the case, including Criminal Investigator Sandra Adams, of the District of Columbia’s Office of the Inspector General, Medicaid Fraud Control Unit; Civil Enforcement Investigator Karen Caudill, of the U.S. Attorney’s Office, and Accountant Charles Ross, also of the U.S. Attorney’s Office. They also expressed appreciation for the assistance provided by the FBI’s Washington Field Office. Finally, they acknowledged the efforts of Assistant U.S. Attorney Beverly M. Russell, of the U.S. Attorney’s Office, Attorney Stuart Silverman, of the District of Columbia’s Office of Inspector General, Medicaid Fraud Control Unit, and the Public Advocacy Section of the
District of Columbia's Office of the Attorney General.