Press Release  AG Campbell Reaches $2.6M Settlement With Leominster-Based Ambulance Company, MedStar, To Resolve False Billing Allegations

BOSTON — Attorney General Andrea Joy Campbell and her office have reached a $2.6 million settlement with MedStar Ambulance, Inc., along with its parent corporation and affiliates, to resolve allegations that the company submitted false claims to MassHealth, the state’s Medicaid program. Based in Leominster, MedStar provides services in multiple cities and towns in Central and Western Massachusetts, including Chicopee, Fitchburg, Leominster, Northampton and Worcester. 

The AG’s Office contends that MedStar Ambulance, Inc., its parent corporation, Critical Systems, Inc., and its affiliates, Fitchburg Emergency Medical Services, Inc., MedStar EMS, Inc., MetroWest Emergency Medical Services Inc., and Pioneer Valley Emergency Medical Services., knowingly submitted false claims to MassHealth for emergency ambulance services, when only a less expensive nonemergency level of service was provided. 

Additionally, the Office alleges MedStar did not follow MassHealth regulations because it provided nonemergency ambulance services or wheelchair van services without appropriate medical necessity documentation. Furthermore, the Office alleges that MedStar submitted claims to MassHealth for services where they had not actually shown the appropriate medical necessity documentation to the authorized provider who was signing it.  

“The MassHealth program only works when providers play by the rules – and my office will continue to hold those who don’t accountable,” said AG Campbell. “By doing so, we can and will protect the integrity of MassHealth and ensure its purpose to provide crucial health care support for the most vulnerable remains intact.” 

Under the terms of the settlement, in addition to paying back $2.6 million to MassHealth, MedStar has agreed to implement company-wide training and update its policies related to its compliance with MassHealth medical necessity requirements. 

 This matter was handled by Deputy Chief Kevin Lownds, Assistant Attorney General Matthew Jones, and Senior Healthcare Fraud Investigator William Welsh, all of AG Campbell’s Medicaid Fraud Division. MassHealth provided substantial assistance with this investigation. 

 The AG’s Medicaid Fraud Division is a Medicaid Fraud Control Unit, annually certified by the U.S. Department of Health and Human Services to investigate and prosecute health care providers who defraud the Medicaid program (MassHealth). The Medicaid Fraud Division also has jurisdiction to investigate and prosecute complaints of abuse, neglect and financial exploitation of residents in long-term care facilities and of Medicaid patients in any health care setting. 

 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 $5,542,963 for Federal fiscal year 2023. The remaining 25 percent, totaling $1,847,641 for FY 2023, is funded by the Commonwealth of Massachusetts.

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