Press Release  AG Healey’s Medicaid Fraud Division Recovers More Than $45 Million for MassHealth in Fiscal Year 2020

BOSTON — Attorney General Maura Healey announced today that her Medicaid Fraud Division has recovered more than $45 million for the state’s Medicaid program (MassHealth) in federal fiscal year 2020 (Oct. 1, 2019 through Sept. 30, 2020).

The AG’s Medicaid Fraud Division investigates and prosecutes those who defraud the MassHealth program. The Division is also responsible for reviewing complaints of abuse, neglect, mistreatment, and financial exploitation of patients in long-term care facilities.

 The Division secured 27 civil settlements with various entities, including home health agencies, mental health centers, ambulance providers, and individual doctors and practices. An additional 11 providers and individuals were criminally charged for defrauding MassHealth and three individuals were criminally charged with abuse, neglect, or financial misappropriation in long-term care facilities.

“I am proud of the work our Medicaid Fraud Division does each day on behalf of vulnerable residents in Massachusetts, taxpayers, and to protect the integrity of MassHealth,” said AG Healey. “Each year, the Division returns tens of millions of dollars to the state, ensures important health care funds are spent appropriately, and continues to be a national leader in this space.”

 The Division continued to work to combat fraud among providers who deliver home-based services. In December 2019, two individuals, John and Joanne Wachira, and their company, Petra Healthcare, LLC, were indicted in connection with a scheme to falsely bill MassHealth while exploiting homeless individuals. Also in December 2019, a Brighton adult foster care company, Absolute Care, Inc., agreed to pay $3 million to resolve allegations that it had falsified caregiver timesheets and submitted claims for dates on which care was not provided. The Division also recovered $450,000 in April 2020 from an Avon-based home health company, Brigham Home Care Services, over allegations that it violated MassHealth regulations and state law by submitting false claims to MassHealth for payment. In September 2020, a Lowell-based home health company, Altranais Home Care, LLC, agreed to pay $3.1 million to resolve allegations that it had billed MassHealth for home health services that were not appropriately authorized by a physician.

The physical safety and financial security of residents in Massachusetts nursing homes remained a priority for the Division. In September 2020, AG Healey announced criminal neglect charges against the former Superintendent and former Medical Director of the Soldiers’ Home in Holyoke. Those charges are based on allegations that they were responsible for the decision to place veterans who did not have symptoms of COVID-19 in a single unit with veterans who were symptomatic or positive for COVID-19, increasing the asymptomatic veterans’ exposure to the virus. In September 2020, the Division also indicted a former Waltham nursing home admissions director in connection with an alleged scheme to steal hundreds of thousands of dollars from an elderly resident.

The Division also worked to ensure high-quality behavioral health services for MassHealth members. In July 2020, the Division announced the resolution of the United States et al. ex rel. Escobar et al. v. Universal Health Services, Inc. et al., (Escobar) case, in which the Division alleged that the defendants caused the submission of claims for services provided by unlicensed and non-independently licensed staff who were not properly supervised. As part of that settlement, Defendant Universal Health Services (UHS) agreed to pay $10 million. In a second settlement agreement, Massachusetts joined other states and the federal government to settle allegations of fraud against UHS arising from UHS’s inpatient and residential psychiatric and behavioral health facilities, which resulted in Massachusetts receiving nearly $5.5 million. Both of these resolutions require the company to implement multi-year independent compliance monitoring programs.

The Division continued its longstanding role in combatting fraud in the dental industry, while collaborating with other federal and state agencies. In January 2020, in a joint investigation and prosecution with the U.S. Attorney’s Office, prosecutors announced charges against a Worcester dentist, a Chelmsford dentist, and a Worcester office manager for their participation in a scheme to defraud MassHealth. In February 2020, in a joint investigation with the U.S. Department of Health and Human Services, Office of the Inspector General, the Division announced a settlement with a Canton dentist, Dr. Nathaniel Chan, who agreed to pay $135,000 to resolve allegations that he was running an illegal kickback scheme.

The Division has continued to maintain a national presence within the National Association of Medicaid Fraud Control Units (NAMFCU). Once again, Assistant Attorneys General and Investigators presented at the annual conference and have acted as facilitators at NAMFCU trainings. The Division regularly plays a leadership role in national initiatives and in multi-state false claims cases.

Medicaid is a multi-billion-dollar joint state and federal program that provides health care coverage for the economically disadvantaged. The Division works cooperatively with MassHealth and other state and federal agencies to prosecute provider fraud in the Massachusetts Medicaid program. Many of the cases handled by the AG’s Office were referred by MassHealth, as well as state and federal agencies and law enforcement partners.

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.

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