Former Charlestown Nonprofit to Pay More Than $94,000 for Billing MassHealth for Services Allegedly Not Provided
Life Focus Center Submitted False Claims by Billing for Hours of Day Habilitation Services Not Rendered to an Individual with Developmental Disabilities
BOSTON – A former Charlestown nonprofit that provided day habilitation services to individuals with developmental disabilities has agreed to pay more than $94,000 to settle claims of billing the state’s Medicaid program (MassHealth) for services not provided, Attorney General Maura Healey announced today.
According to the settlement, Life Focus Center of Charlestown, Inc. allegedly violated the Massachusetts False Claims Act by billing more hours of service than were actually provided to a MassHealth member from 2008 through 2011, resulting in overpayments.
Life Focus Center provided day habilitation services to individuals with mental retardation and other developmental disabilities with the goal of helping each member reach his or her optimal level of physical, cognitive, psychosocial, and occupational capabilities. Under MassHealth regulations, day habilitation providers will not be paid for any cancelled sessions or sessions missed by a member, and will not pay for any portion of a day during which the member is absent from the site, unless the provider documents that the member received services from the program staff in a community setting.
Day habilitation services are provided by a team consisting of a licensed registered nurse, a licensed occupational and physical therapist, a speech and language therapist, a psychologist, and a rehabilitation counselor. Sessions are billable in 15-minute units. Under MassHealth regulations, providers must report the actual time spent by each member in the program.
According to the settlement, from December 2008 to February 2011, Life Focus Center allegedly engaged in a scheme where it billed MassHealth for day habilitation services not rendered to a developmentally disabled MassHealth member who either did not attend at all or rarely attended the day habilitation program. MassHealth relied upon Life Focus’ alleged false claims submitted for the member’s day habilitation services and reimbursed Life Focus Center as if it had provided full days of service.
This investigation against Life Focus Center was initially referred to the AG’s Office by MassHealth following a review of its billing. In June 2012, Life Focus Center ceased its operations and Bay Cove Human Services assumed operation of the program. Under the terms of the settlement, Life Focus Center has also agreed to no longer participate as a MassHealth provider.
The matter was investigated by Assistant Attorneys General Angela Neal and Gregory Matthews of Attorney General Maura Healey’s Medicaid Fraud Division, with assistance from MassHealth and the State Auditor’s Office.