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Pennsylvania Lifesharing, LLC (PAL) has agreed to pay over $1.2 million to resolve allegations that it submitted fraudulent claims to Medicaid for services provided by unqualified staff. According to the U.S. Attorney’s Office for the Middle District of Pennsylvania, the company is accused of violating the False Claims Act by allowing Direct Support Professionals (DSPs) who were not properly cleared or trained to provide one-on-one services to patients. This settlement addresses claims made between January 1, 2022, and December 31, 2024.
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The investigation revealed that PAL submitted claims to Medicaid for services rendered by DSPs whom the company knew were not adequately vetted or trained, rendering them unqualified for the essential one-on-one support required by Medicaid regulations. Ensuring that individuals receiving care are being attended to by properly qualified personnel is a critical aspect of maintaining the integrity of healthcare programs. Agencies like the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) are committed to investigating such allegations of improper billing and safeguarding the Medicaid program.
Following the initiation of the investigation, PA Lifesharing, LLC cooperated with federal authorities. The company reportedly identified some of the improper claims on its own and took steps to rectify the issues that led to the false submissions. This settlement resolves a lawsuit that was originally filed under the qui tam provisions of the False Claims Act. These provisions allow private individuals, often referred to as whistleblowers, to file lawsuits on behalf of the United States. If successful, these whistleblowers are entitled to a portion of the recovered funds. In this case, the whistleblower will receive more than $242,000 from the total settlement amount.
The case was managed by Assistant U.S. Attorney Tamara Haken and the Affirmative Civil Enforcement Unit of the U.S. Attorney’s Office for the Middle District of Pennsylvania, with significant assistance from the HHS-OIG.
Article by Mel Anara, based upon information from the U.S. Attorney’s Office for the Middle District of Pennsylvania
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