Bend man, affiliated home care company agree to pay $2.9 million settlement of fraudulent claims

Prosecutors: Firm altered caregiver schedules, billed Medicaid for in-home care not actually performed

PORTLAND, Ore. (KTVZ) — A Bend resident and his residential care company have agreed to pay $2.9 million to settle federal and state allegations that the firm submitted false reimbursement claims to Oregon's Medicaid program, federal prosecutors said Thursday.

Kevin Cox, 51, and At Home Care LLC, doing business as At Home Care Group (AHCG), will pay $1.86 million to the United States and $1.04 million to the state of Oregon.

AHCG also waived indictment and pleaded guilty Thursday in Deschutes County Circuit Court to two counts of making a false claim for health care payment.

“Individuals and companies who submit false claims to federally-backed state health care programs increase health care costs for everyone,” said Scott Erik Asphaug, acting U.S. attorney for the District of Oregon. “We take health care fraud very seriously and will continue to hold accountable those who undermine the integrity of these important programs.”

“This national pandemic has put an unprecedented strain on our health care system. There is never a time for Medicaid providers to enrich themselves with fraudulent schemes—but now is certainly not the time. This case shows you that we will work aggressively with our federal law enforcement partners to investigate and prosecute providers that victimize our most vulnerable Oreognians and the programs that serve them,” said Attorney General Ellen F. Rosenblum.

“Health care providers should regard Medicaid as a lifeline for vulnerable beneficiaries in need of wellness services, not as a financial reserve for personal enrichment,” stated Steven Ryan, special agent in charge with the U.S. Department of Health and Human Services. “To assist in preserving Federal health care programs, our agency and law enforcement partners investigate and cease wrongful activity that compromises their funds.”

AHCG provided in-home medical and non-medical care to individuals in Oregon. Federal and state prosecutors contend that between March 2013 and September 2018, AHCG altered caregiver scheduling calendars and billed the Oregon Medicaid program for hours of in-home care not actually performed.

As part of the settlement, AHCG and Cox will be excluded from participating in Medicare, Medicaid and all other federal health care programs for 15 and eight years, respectively.

Acting U.S. Attorney Asphaug and Attorney General Rosenblum made the announcement.

This settlement was the result of a coordinated investigation by the U.S. Attorney’s Office for the District of Oregon, U.S. Department of Health and Human Services Office of Inspector General, Oregon Department of Justice Medicaid Fraud Unit, and Oregon Health Authority. The United States was represented in this matter by Alexis Lien, Assistant U.S. Attorney for the District of Oregon. Senior Assistant Attorney General Elizabeth Ballard Colgrove led this case for the Oregon Department of Justice.

The claims resolved by this settlement, except for those admitted in AHCG’s guilty plea, are allegations only, and there has been no determination or admission of liability.