- Office of Attorney General Maura Healey
Media Contact for AG Healey Secures $1.2 Million From Brockton Home Health Agency That Falsely Billed MassHealth
BOSTON — A home health agency and its owners will pay $1.2 million and enter into a comprehensive compliance program to resolve allegations that they falsely billed the state’s Medicaid Program (MassHealth), Attorney General Maura Healey announced today.
The settlement with Independent at Home (“Independent”) in Brockton and its owners, Loretta Ihedioha and Corona Robinson, resolves allegations that, since December 2013, they knowingly submitted false claims to MassHealth and managed care entities (MCEs) administering services to MassHealth members for home health services that had not been appropriately authorized by a physician. Independent also allegedly submitted false claims for home health services that it did not provide, as members were residing in inpatient facilities at the time Independent billed for services.
“This company’s years of false billing has taken away state resources from the people who need it most,” said AG Healey. “We will continue our work to hold bad actors in the home health industry accountable for fraudulent behavior and are proud to have brought back millions to Massachusetts as a result of our investigations.”
To bill MassHealth for home health services, the member’s physician must review and sign a plan of care that certifies the home health care services as medically necessary. Home health agencies are required to maintain records of services provided to each member for at least six years. The AG’s investigation began following a referral by the U.S. Department of Health and Human Services, Office of the Inspector General.
According to the AG’s Office, Independent, Ihedioha, and Robinson knew that they had inappropriately received payments as a result of their submission of false claims, but made no attempt to notify MassHealth or return any money.
As part of the settlement, in addition to a payment of $1.2 million, the company also agreed to implement a three-year compliance program. The program will be overseen by an independent compliance monitor, paid for by Independent, and will include updated policies and procedures and staff training to ensure compliance with MassHealth regulations. The independent compliance monitor will also conduct annual on-site audits and report deficiencies and overpayments to the AG’s Medicaid Fraud Division.
This settlement is part of a larger effort by AG Healey and MassHealth to combat fraud in the home health industry. Since 2016, the AG’s office has successfully prosecuted three home health agencies and their owners and settled civilly with ten home health agencies, an effort which has returned more than $42 million to MassHealth. In March 2021, Lifod Home Health Care LLC agreed to settle for $1.25 million to resolve similar allegations of false billing, and in December of 2020, Maestro-Connections Health Systems, LLC agreed to pay $10 million to resolve allegations that it fraudulently submitted claims for unauthorized services.
This matter was handled by Assistant Attorney General Gregoire Ucuz, and Investigators Heather Dwyer and Mirlinda Sejdiu of the AG’s Medicaid Fraud Division, with substantial assistance from MassHealth and the U.S. Department of Health and Human Services, Office of the Inspector General.
The Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award. The remaining 25 percent is funded by the Commonwealth of Massachusetts.