Health Care Company That Improperly Billed Hundreds of Masshealth Members Paying More Than $750,000
Company Allegedly Directly Billed Members for Services Covered by State Medicaid Program; Settlement Returns Money to Hundreds of Members, Provides for Credit Repair
BOSTON – A nationwide provider of home healthcare products will pay more than $750,000 for directly billing people for services covered by the state’s Medicaid program (MassHealth), Attorney General Maura Healey announced today.
Today’s settlement provides refunds to hundreds of affected MassHealth members.
Under the terms of the assurance of discontinuance and related settlement agreement, Apria Healthcare LLC (Apria) has agreed to pay $99,008 in restitution and $665,934 in penalties to resolve allegations that the company directly billed members for services that were already covered by MassHealth.
“MassHealth provides critical healthcare to low-income individuals, including people with disabilities, children and senior citizens, yet this company billed them for services that were already covered,” AG Healey said. “Through our settlement with Apria, hundreds of members who paid bills they did not owe will get their money back.”
Apria provides medical services and devices, including durable medical equipment, to MassHealth members and has two Massachusetts locations in Springfield and Wilmington.
The AG’s Medicaid Fraud Division began an investigation after the matter was referred by MassHealth’s Provider Compliance Unit and the UMass Medical School Enhanced Coordination of Benefits Division, who received complaints from members that Apria was trying to collect money from them for services covered by MassHealth.
The AG investigation revealed that between December 2011 and April 2017, Apria inappropriately billed more than 1,000 members for hundreds of thousands of dollars of services already covered by MassHealth, in violation of MassHealth regulations and state consumer protection laws. The AG’s Office estimates that more than 500 of those patients paid those bills and will receive restitution from this settlement.
The AG’s settlement with Apria requires that the company cooperate with the AG’s Office to repair the credit of any consumers whose claims were sent to third-party collection agencies and whose credit scores may have been negatively impacted. It also requires the company to institute a compliance monitoring program.
This matter was handled by Assistant Attorney General Nita Klunder and Investigator Robert Ames, both of AG Healey’s Medicaid Fraud Division. MassHealth assisted in this investigation.