Press Release  AG Campbell Announces More Than $2.5 Million In Fraud Settlements With Two Autism Services Providers

BOSTON — Attorney General Andrea Joy Campbell has reached settlements with two applied behavioral analysis (ABA) providers totaling more than $2.5 million to resolve allegations that the providers submitted fraudulent claims to MassHealth. 

ABA services are principally designed to treat children with autism spectrum disorder, a neurodevelopmental disorder characterized by difficulties in social interaction, impaired communication, and repetitive restrictive behaviors.

One of the settlements involves Ubuntu Autism Consultants, LLC (Ubuntu), formerly of Worcester, Autism Behavioral Links, Inc., of Framingham, and Ian Gatheca, the owner of both companies. The settlement requires Ubuntu and Gatheca to pay $1.7 million to resolve allegations that they submitted false claims to MassHealth managed care entities (MCEs) for ABA services that were not provided by individuals with the appropriate credentials for the service in question. 

The second settlement is with Autism Resources and Therapy Center (ARTC), of Westborough, and its owner Mary Wangari.  The settlement requires ARTC and Wangari to pay $825,000 to resolve allegations that they billed MCEs for ABA services that were either not rendered and/or not properly documented, and for failing to provide adequate supervision of ARTC’s paraprofessional staff.

“The defendants involved in these two settlements not only failed to comply with the necessary standards for providing critical services to a vulnerable population with autism spectrum disorder, but also fraudulently exploited public funds,” said AG Campbell. “These resolutions ensure that these companies will pay back the money they owe MassHealth and bring themselves into compliance with required state laws and regulations, so our youth receive the high-quality ABA services they deserve.”

In addition to the financial settlements, under the terms of both agreements, both providers have agreed to implement a three-year independent compliance monitoring program at their own expense, which will result in updates to their policies and procedures, new trainings for employees, and periodic audits to ensure compliance with all applicable state and federal laws.

ABA services focus on the analysis, design, implementation, and evaluation of social and other environmental modifications to produce meaningful changes in behavior.  While many of the services are delivered by paraprofessional staff, often referred to as behavioral technicians, MassHealth and its MCEs require that treatment planning and family training be conducted by Licensed Applied Behavioral Analysts (“LABAs”).  MassHealth and its MCEs also require LABAs to provide supervision at specified intervals to behavioral technicians.

The AG’s Office began investigating Ubuntu following a referral by MassHealth.  The AG’s Office alleges that Ubuntu billed for services that can only be provided by LABAs even when those services were not provided by a LABA.  The AG’s Office also found that Ubuntu billed for services provided by behavioral technicians, even if those behavioral technicians had not received appropriate supervision from a LABA.

The AG’s Office began investigating ARTC following a referral by MassHealth. The AG’s Office alleges that ARTC, like Ubuntu, billed for services provided by behavioral technicians who had not received appropriate supervision from a LABA.  The AG’s Office also alleges that ARTC lacked supporting documentation to substantiate that some of the services it billed had actually been provided.

The Ubuntu matter was handled by Deputy Chief Kevin Lownds, Assistant Attorney General William Champlin IV, Investigations Supervisor Dean Bates, Senior Healthcare Fraud Investigator Heather Dwyer, and Senior Healthcare Fraud Investigator William Welsh, all of the AG’s Medicaid Fraud Division.  The ARTC matter was handled by Assistant Attorney General Matthew Jones, Senior Healthcare Fraud Investigator William Welsh, and Investigator Julia Galvao, also of the AG’s Medicaid Fraud Division.  MassHealth and its MCEs provided substantial assistance with both investigations.

The Massachusetts Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $5,865,996 for federal fiscal year 2024. The remaining 25 percent, totaling $1,955,330 for FY 2024, is funded by the Commonwealth of Massachusetts.

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