Press Release  Lawrence Physician to Pay $515,000 over Allegations of False Billing and Charging Cash for Suboxone

Boston — A Lawrence physician and members of his practice will pay $515,000 to resolve allegations that they charged patients cash for a substance use disorder treatment already covered by the state’s Medicaid program (MassHealth), and billed for office visits that should have been performed by a physician but were instead performed by unlicensed medical assistants, Attorney General Maura Healey announced today.

According to the settlement agreement with the AG’s Office, from December 2013 through December 2019, Dr. Miguel Verdaguer, office manager Christina Verdaguer, and Health Independent Providers, Inc., of Lawrence (HIP), charged MassHealth patients cash fees for covered urine drug screens related to Suboxone treatment in violation of state law. The AG’s Office also alleges that they billed MassHealth for physician office visits that were performed by medical assistants as if those visits had been performed by Dr. Verdaguer himself.

“Putting up barriers to substance use disorder treatment makes it harder for patients to get this lifesaving care,” said AG Healey. “This alleged behavior puts people’s safety at risk, and we will continue to investigate and prosecute providers that take advantage of these vulnerable individuals.”

As part of the settlement agreement, $243,920 will be paid in restitution to current and former patients. Suboxone and other formulations of buprenorphine are used for the treatment of opioid use disorder by suppressing withdrawal and cravings for opioids.

By law, MassHealth providers are required to accept payments from MassHealth as payment in full for covered substance use treatment services provided to MassHealth recipients.

In addition to the financial settlement, an assurance of discontinuance was filed in Suffolk Superior Court. HIP will also implement a multi-year independent compliance program that will provide regular reports to the AG’s Office.

In November 2017, AG Healey sent a letter alerting doctors who provide substance use disorder treatment that the office will take action against those who unlawfully require cash payments from MassHealth members for covered treatments.

The AG’s Office has investigated numerous cases and brought criminal and civil enforcement actions against MassHealth providers who solicited and received cash payments from MassHealth members for covered addiction treatment and continues to actively investigate and prosecute such cases throughout the state. A practice in Norfolk recently paid $150,000 to resolve similar cash for suboxone allegations against them. In January 2019, a Dorchester doctor pleaded guilty in connection with charging patients cash for suboxone treatment already covered by MassHealth and was sentenced to house arrest and required to surrender his medical license.

Members of the public who are aware of similar practices by other health care providers should call the Attorney General’s Medicaid Fraud Division at (617) 963-2360 or file a complaint through the Attorney General’s website.

This matter was handled by Managing Attorney Jennifer Goldstein, Investigations Supervisor Christopher Cecchini, Senior Healthcare Fraud Investigator Steven Pfister, and Investigator William Welsh all of AG Healey’s Medicaid Fraud Division, with assistance from the Diversion Unit of the Drug Enforcement Agency’s Boston Office. 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.

###