- Office of Attorney General Maura Healey
Media Contact for AG Healey Secures $1.25 Million From Lawrence Home Health Care Company That Falsely Billed MassHealth
BOSTON — In ongoing efforts to combat fraud in the home health industry, Attorney General Maura Healey announced today that her office reached a $1.25 million settlement with a Lawrence-based home health care company and its owner to resolve allegations that they falsely billed the state’s Medicaid Program (MassHealth) for services that were not properly authorized by a physician.
Pursuant to a settlement agreement with the AG’s Office, Lifod Home Health Care LLC (Lifod) and CEO Kariuki Kimungu will pay $1.25 million to resolve allegations that, since May 1, 2015, they knowingly submitted false claims to MassHealth and managed care entities administering services to MassHealth members for unauthorized home health services.
“This kind of illegal conduct takes funds away from MassHealth, which provides critical health care services to low-income and vulnerable residents across the state,” said AG Healey. “We are committed to combatting fraud, waste, and abuse in the home health industry and will continue to take action against companies that don’t abide by state laws and regulations.”
To bill MassHealth for home health services, a provider must ensure that the member’s physician has reviewed and signed 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 presented for payment. The AG’s Office alleges that Lifod billed for services for which it did not have valid, signed plans of care certifying that those services were medically necessary.
In addition to the financial payment, the settlement also includes a requirement that Lifod must operate under a multi-year compliance program, overseen by an independent compliance reviewer. That program will include updated policies and procedures, new training for staff, and yearly audits conducted by the reviewer.
Today’s 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 nine home health agencies. In December 2020, Maestro-Connections Health Systems paid $10 million for falsely billing MassHealth for unauthorized services and in October 2020, Altranais Home Care of Lowell paid $3.1 million to resolve similar allegations. In April 2019, Avenue and Amigos Home Care paid a combined $10 million to resolve allegations of false billing, and in August 2019, Guardian Healthcare paid $1.95 million over similar conduct. In May 2019 and August 2018, juries convicted owners of home health care agencies in connection with other schemes to defraud MassHealth. In December 2019, another home health agency, Petra Healthcare, LLC, and its co-owners, were indicted in connection with a scheme to exploit transient individuals in a housing-for-services kickback scheme.
AG Healey’s Medicaid Fraud Division recovered more than $45 million for MassHealth in federal fiscal year 2020.
This matter was handled by Assistant Attorney General Gregoire Ucuz and Investigator Katie Suttmeier, both of the AG’s Medicaid Fraud Division, with substantial assistance from MassHealth.
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.