Revere Physician to Pay More Than $53,000 in Restitution After Allegedly Charging MassHealth Patients Illegal Fees
BOSTON – A Revere physician who improperly charged a $185 administrative fee in addition to MassHealth reimbursements for opioid addiction treatment will pay more than $53,000 in restitution, Attorney General Martha Coakley announced today.
“Our office will make sure that access to addiction treatment is not restricted by providers requiring illegal cash payments,” AG Coakley said. “We are happy that we obtained restitution for those battling drug addiction who were allegedly taken advantage of when they needed help the most.”
Randall Bock, M.D., was referred to the AG’s Medicaid Fraud Division by MassHealth, the state’s Medicaid program, for allegations of improperly taking an “administrative fee” of $185 from MassHealth members in addition to MassHealth reimbursement for opioid addiction treatment with the drugs Suboxone and Subutex. Suboxone is the brand name for the combination of buprenorphine and naloxone, an alternative to methadone that must be administered daily in a federally approved clinic setting. Suboxone was approved by the FDA for office-based treatment of opioid addiction in October 2002.
The demand for Suboxone treatment far exceeds the supply of physicians authorized to prescribe it in Massachusetts. Only about two percent of Massachusetts physicians are authorized. As a result, some physicians have taken advantage of this supply-demand imbalance by charging patients cash in addition to MassHealth reimbursement for Suboxone treatment. This practice is illegal.
MassHealth members may only be charged a small copayment for certain drugs and inpatient hospital stays. Physicians are not allowed to charge copayments to MassHealth members for office visits. Any MassHealth member who feels that he or she is being charged an illegal copayment for MassHealth services or goods is urged to call the AG’s Medicaid Fraud Complaint Line at (617) 963-2360 or use the online Medicaid Fraud Complaint Form.
In addition to the financial terms of the settlement, Dr. Bock entered into an Assurance of Discontinuance filed Tuesday in Suffolk Superior Court agreeing not to charge an “administrative fee” to MassHealth members or to solicit, charge or receive any money from MassHealth members for any service which is payable by MassHealth.
Buprenorphine works by binding to the opioid receptors in the brain, suppressing withdrawal symptoms and reducing craving. It produces a sense of well-being but not the euphoria associated with heroin or oxycodone. Suboxone is considered by addiction experts to be an extremely effective treatment for opioid addiction.
Dr. Bock cooperated fully with the Attorney General’s Office in this investigation. By entering into today’s settlement agreement, Dr. Bock does not admit or deny the Attorney General’s or MassHealth’s allegations.
This matter was investigated by Assistant Attorney General Steven Hoffman and Investigators Timothy St. Laurent and Ronald Velez of the Attorney General’s Medicaid Fraud Division. Assistance was provided by the Massachusetts State Police, Revere Police and MassHealth.