- Office of Attorney General Maura Healey
Media Contact for Lowell Home Health Care Company to Pay $3.1 Million for Falsely Billing MassHealth
BOSTON — A home health care company and its owners will pay $3.1 million to resolve allegations that they falsely billed the state’s Medicaid Program (MassHealth), Attorney General Maura Healey announced today.
Altranais Home Care, LLC (Altranais) of Lowell and its owners, Constant Ogutt and Shakira Lubega, will pay $3,110,000 to resolve allegations that, since January 2014, they knowingly, or in reckless disregard of billing requirements, submitted false claims to MassHealth and MassHealth Managed Care Entities for home health services that had not been appropriately authorized by a physician.
“Home health companies have an obligation to provide only those services that are medically necessary,” said AG Healey. “This company allegedly defrauded MassHealth and improperly used scarce resources for services that were not deemed necessary by a physician.”
“Today’s outcome is the result of MassHealth’s strong program integrity efforts to prevent fraudulent billing, and demonstrates the ongoing relationship between MassHealth and the Medicaid Fraud Division,” said Assistant Secretary for MassHealth and Medicaid Director, Dan Tsai.
To bill MassHealth for home health services, a member’s physician must review and sign 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 this company billed for services for which it did not have valid, signed plans of care.
In addition to the financial settlement, the company must operate under a multi-year independent compliance program. This program will be implemented by an independent compliance monitor and will require the company to establish updated policies and procedures ensuring compliance with federal and state laws and regulations, conduct annual training for all employees on those policies and procedures, and perform annual audits to confirm that they remain in compliance with all applicable state and federal laws and regulations, the results of which will be reported to the AG’s Office.
This settlement is part of a larger effort by AG Healey and MassHealth to combat fraud in the home health industry. In April 2019, Avenue and Amigos Home Care paid a combined $10 million to resolve allegations of similar false billing, and in August 2019, Guardian Healthcare paid $1.95 million to resolve similar allegations. In May 2019 and August 2018, juries convicted owners of home health care agencies in connection with other schemes to defraud MassHealth.
This matter was handled by Assistant Attorney General Gregoire Ucuz and Investigators Heather Dwyer and Johan Gonzalez, all of the AG’s Medicaid Fraud Division. MassHealth, the U.S. Department of Health and Human Services, and the Office of the Inspector General provided substantial assistance in this matter. 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.