- Office of Attorney General Maura Healey
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Emalie Gainey
Boston — Continuing her commitment to rooting out fraud in public assistance programs and recovering taxpayer dollars, Attorney General Maura Healey today announced that her Medicaid Fraud Division recovered more than $80 million for the state’s Medicaid program in 2016, the second highest amount recovered for the program in a single year to date.
The AG’s Medicaid Fraud Division is responsible for the investigation and prosecution of fraud against the state’s Medicaid program, known as MassHealth. The Division recovered nearly $20 to every dollar they were allocated in their 2016 fiscal year budget.
“Medicaid is 40 percent of the state’s budget and it must be protected,” AG Healey said. “Each year our office recovers millions of dollars for MassHealth to ensure that taxpayer funds are used properly to benefit our residents.”
AG Healey’s Office continues to maintain a leadership position nationally in the fight against fraud, waste and abuse in the Medicaid program. The $80 million recovered in 2016 is primarily the result of 29 civil settlements, 19 of which were multistate agreements.
Representatives from the AG’s Medicaid Fraud Division serve on national multistate fraud teams that negotiate the resolution of these cases, which in 2016 resulted in the return of approximately a billion dollars to the federal government and state Medicaid programs across the country.
In 2016, representatives from the AG’s Medicaid Fraud Division served as the lead negotiators for a multistate litigation team that worked with the federal government to secure the largest Medicaid fraud recovery in state history. In the May settlement, pharmaceutical manufacturer Wyeth, Inc., a wholly owned subsidiary of Pfizer, Inc., agreed to pay nearly $68 million to MassHealth to resolve claims that it knowingly underpaid mandated drug rebates. The payment was part of a joint multistate and federal settlement totaling $784.6 million.
In addition to multi-state settlements, representatives of AG Healey’s Medicaid Fraud Division negotiated a variety of cases for Massachusetts that achieved substantial settlements from various entities including pharmacies, doctors, a transportation company, and a dental practice. The Division prioritized cases involving prescribers, pharmacists and others who contribute to the opioid epidemic by illegally prescribing or dispensing pills.
In a first-in-the-nation settlement, AG Healey announced a $795,000 settlement in September with CVS Pharmacy, Inc. in which it agreed to strengthen its policies and procedures around the dispensing of opioids and require its Massachusetts pharmacy staff to check the state’s Prescription Monitoring Program before filling prescriptions for commonly misused opioids. A Youth Opioid Prevention grant program was set up utilizing $500,000 of this settlement.
Dr. Joshua Golden, a psychiatrist practicing with United Health Associates in Sharon and Attleboro, paid $363,150 to resolve allegations that he required patients who were MassHealth members to pay out-of-pocket fees in order to receive the drug Suboxone, when they were entitled to receive treatment for free. The payment included $288,150 in restitution for 107 MassHealth members and a $75,000 penalty to Massachusetts.
The AG’s Medicaid Fraud Division also reached a $700,000 settlement in July with REM Transportation Services, LLC, resolving allegations that it submitted false claims to MassHealth for medically unnecessary wheelchair van rides and for services that should have been provided at a lower cost through a MassHealth transportation broker.
In January, a Boston dentist agreed to pay $650,000 to MassHealth to resolve allegations of improperly billing for dental work at her offices in Everett, South Boston, and Malden. Dr. Ekaterina Mamulashvili and her professional dental practices improperly and frequently used multiple oral examination codes to bill MassHealth for services received by the same patients on the same day.
In addition to the civil settlements, six individuals were convicted in 2016 after the Medicaid Fraud Division brought criminal charges against them for defrauding MassHealth. An additional 14 people were criminally charged by the Division in 2016 and their cases are currently pending.
In March, Dr. Mohammad Nassery, who practiced at Ariana Pediatric Neurology in Hyannis, pleaded guilty and was sentenced in connection with illegally prescribing oxycodone and other oxycodone-based medications to patients despite their documented substance abuse, and after learning that some patients were concurrently enrolled in substance abuse treatment programs or were receiving opioids from other prescribers. Nassery was ordered to pay full restitution in the amount of $10,278 to MassHealth.
Twin sisters Nita Guzman and Nina Tischer were also convicted for stealing from public agencies by billing for unlicensed psychological services. Tischer was ordered to pay more than $34,000 in restitution and Guzman was sentenced to jail and will pay up to $570,000 pending a restitution hearing scheduled for Feb. 7.
Medicaid is a multi-billion-dollar joint state and federal program that provides health insurance for the economically disadvantaged. The Medicaid Fraud Division works cooperatively with MassHealth and other state and federal agencies to prosecute fraud against the Massachusetts Medicaid program.
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