News  AG Healey Announces $10 Million in Recoveries from Home Health Care Companies for Falsely Billing MassHealth

Boston — Two home health care companies will pay over $10 million to resolve allegations that they falsely billed the state’s Medicaid Program (MassHealth), Attorney General Maura Healey announced today.

Amigos Homecare, LLC (Amigos) of Lawrence will pay $2,130,000 and Avenue Homecare Services, Inc. (Avenue) of Dracut will pay $8,305,300 to resolve allegations that both entities submitted false claims to MassHealth for home health services that had not been appropriately authorized by a physician.

“These companies defrauded the state and diverted vital resources from elderly and disabled patients,” said AG Healey. “Home health care companies must provide services that are medically necessary, follow MassHealth regulations, and keep accurate records to ensure the integrity of this program.”

To bill MassHealth for home health services, a member’s physician must review and sign a plan of care certifying that home health services are medically necessary. Home health agencies are required to maintain these records for at least six years after the medical services are provided and claims have been made. In both cases, the AG’s Office alleges that these health care companies billed for services for which they did not have valid, signed plans of care.

Investigators allege that from June 2014 through April 2018, Amigos submitted false claims to MassHealth for unauthorized services. Investigators also identified some claims where MassHealth members could not have been receiving home health services from Amigos because they were hospitalized at the time.

Investigators allege that from August 2013 through June 2016, Avenue submitted similar false claims to MassHealth for home health services that had not been properly authorized by a physician and for home health services billed while the member was hospitalized. 

While these allegations are similar in nature, the two home health care companies are unrelated to each other and are under different management. MassHealth referred both matters to the AG’s Office.

In addition to the financial settlements, both companies, if they wish to provide and bill for services to MassHealth members in the future, must implement multi-year independent compliance programs. Those programs will be implemented by an independent compliance monitor and will require Amigos and Avenue to establish updated policies and procedures governing compliance with federal and state requirements, to conduct annual training for all employees on those policies and procedures, and to perform annual audits to confirm that they remain in compliance with all applicable state and federal laws and regulations, the results of which will be reported to the AG’s Office. 

These civil settlements are part of a larger effort by AG Healey and MassHealth to combat fraud in the home health program. In August 2018, a jury convicted the owner of a Boston home health care agency, on seven counts in connection with a scheme to steal millions from MassHealth. In November 2018, the AG’s Office secured a guilty plea for a Dorchester man and woman who claimed to provide home health services to a deceased individual.

These matters were handled by Assistant Attorney General Kevin Lownds, and Investigators Ruth Zeltzer, Christine Baker, and Erica Schlain, all of the AG’s Medicaid Fraud Division. MassHealth provided critical assistance in these cases.