Press Release  Avon-based Home Health Company to Pay $450,000 to Resolve Allegations of False Medicaid Billing

Boston — An Avon home health agency will pay $450,000 to resolve allegations that it submitted false claims to the state’s Medicaid program (MassHealth), Attorney General Maura Healey announced today.

Under the terms of a settlement agreement, Brigham Home Care Services and its owners, Catherine and Martin Kamandu, will pay $450,000 to resolve allegations that they violated MassHealth regulations and state law by submitting false claims to MassHealth for payment.

“Now more than ever, our state’s health care resources need to be used to help those who are sick and need support,” said AG Healey. “This settlement will return funds to the MassHealth program to ensure that our most vulnerable residents have access to health care services they need.”

The false claims included billing home health services for patients while the patients were outside of their homes attending Adult Day Health Center programs, billing MassHealth for services that were not approved by a physician, billing for services provided by nurses while those nurses were travelling outside the state, billing for services recorded as being provided by the same nurse at the same time to two different members living in separate households, and billing for services without the proper billing modifier codes to secure a higher rate of reimbursement.

In addition to the financial settlement, Brigham will implement a multi-year independent compliance program at their own expense and will provide training and policy changes for all personnel to ensure compliance with all applicable federal and state laws and regulations.  Brigham is required to submit annual compliance and audit reports to the AG’s Office.

Addressing fraud in the home health care industry remains a critical priority for the AG’s Medicaid Fraud Division. In 2019, the Division recovered more than $12 million from home health agencies and prosecuted the owner of Lifestream Home Health, who was convicted on charges in connection with making false claims to MassHealth.

This matter was handled by Assistant Attorney General Christina Chan, Senior Health Care Fraud Investigator Christine Barker and Investigator Mirlinda Sejdiu, of the AG’s Medicaid Fraud Division. MassHealth provided critical assistance to this investigation.

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