Press Release  Adult Day Health Care Facilities to Pay More than $500,000 over Allegations of False Claims and Improper Billing

Boston — Three adult day health facilities have agreed to pay more than $500,000 to settle allegations that they improperly billed the state’s Medicaid Program (MassHealth), Attorney General Maura Healey announced today. 

Under the terms of these settlements, Otrada Adult Day Health Care Ctr., Inc., of Needham, North Shore Adult Day Health Care Center, Inc., of Revere, and Revere Adult Day Health Care Center, LLC of Revere have resolved allegations that they billed for full-day adult day health services for MassHealth members who did not attend full day programs.

“These companies allegedly billed for services not provided, taking away critical funds from seniors who need access to adult day care services,” AG Healey said. “We will continue to protect MassHealth and the essential health coverage it provides for so many across Massachusetts.” 

The AG’s Office alleges that from 2011 through 2018, the three facilities failed to comply with MassHealth regulations that require facilities to track the time MassHealth members are not accompanied by program staff during off-site appointments and failed to provide the facilities’ billing staff with accurate attendance information for MassHealth members.

When a MassHealth member attends the program for less than six hours a day, the provider must bill MassHealth using correct codes for services provided for less than a full day. MassHealth will not reimburse adult day health providers for the portion of a program day during which a member is absent from the site, unless the program documents that the member was receiving services from program staff outside of the facility in a community setting. 

The AG’s Office has resolved previous cases of improper billing at adult day health care facilities. In 2016, the AG’s Office recouped for MassHealth more than $200,000 from ADH Seller, LLC for allegedly billing for services not provided.

This matter was handled by Assistant Attorney General Gregory H. Matthews and Investigators Kaleigh Ross, Eli Ward, and Megan Corrigan of AG Healey’s Medicaid Fraud Division, with significant assistance from MassHealth.

###