- Office of Attorney General Maura Healey
Media Contact for Quincy Woman Arrested, Arraigned for Scheme to Bill Public and Private Insurance for Behavioral Health Services Not Provided
DEDHAM — A Quincy woman has been arrested and arraigned in connection with a fraudulent scheme to bill the state’s Medicaid program (MassHealth) and other private and government-funded plans for behavioral health services that were never provided to patients.
Authorities arrested Nicole Kasimatis, age 47, last Wednesday in Plymouth. Following her arrest, Kasimatis, the owner and operator of Fortitude Counseling and Recovery Center in Quincy, was arraigned Thursday in Norfolk Superior Court on the charges of Medicaid False Claims (2 counts), Larceny over $1,200 (2 counts), Filing a False Health Care Claim (1 count), and Common and Notorious Thief (1 count). Judge Douglas Wilkins set bail at $100,000 with the conditions of home confinement with GPS monitoring, no travel, no contact with witnesses, and cannot bill public or private health insurance, or provide services that could be reimbursed by public or private health insurance. Kasimatis is due back in court on Jan. 12, 2022 for a pre-trial hearing.
These charges are the result of an investigation by AG Healey’s Medicaid Fraud Division into Kasimatis’ billing practices following a referral from the Insurance Fraud Bureau (IFB) and the Norfolk District Attorney’s Office. It is alleged that Kasimatis billed for substance use disorder and/or mental health services she did not perform either because she was incarcerated or out of the country; billed for services not rendered by licensed or supervised Fortitude employees; and billed for services under the name and number of providers who no longer worked for Fortitude and who did not provide the services. The amount of money Kasimatis allegedly obtained from MassHealth as a result of these schemes is more than $480,000. In addition, she obtained at least another $4,800 from private insurances for services not rendered.
“We allege this defendant flagrantly and repeatedly abused her position to profit instead of providing patients with the behavioral health services they need,” said AG Healey. “At a time when quality counseling services are needed more than ever, we cannot allow fraudulent schemes that take away critical resources from our state.”
“Taking advantage of people when they are most vulnerable to defraud insurance carriers is one of the worst kinds of insurance fraud,” said Anthony M. DiPaolo, Executive Director of the Insurance Fraud Bureau. “This is exactly why the Insurance Fraud Bureau of Massachusetts partners with AG Healey’s office to fight insurance fraud.”
Authorities allege that, between 2016 and July 2021, Kasimatis engaged in widespread fraud involving private and public health insurances. Former Fortitude patients told investigators that after they stopped receiving counseling services, their insurance continued to be billed by Fortitude for services not rendered. When two former employees left Fortitude in 2018 and 2019, Kasimatis falsely submitted claims to MassHealth and its Managed Care Entities for 113 different patients listing the former employees as the servicing providers.
During the course of the investigation of private health insurance fraud, investigators discovered that Kasimatis billed over 100 times for services not rendered, where the patients stopped attending sessions at Fortitude, but the billing continued. In at least one instance, a patient went to only one session at Fortitude, but insurance was billed for six additional visits. In another case, a patient went to five counseling sessions, but insurance was billed for an additional 33 visits.
According to the AG’s investigation, Kasimatis used the funds she obtained from her schemes for her own personal use, including paying for international travel, Disney trips, Red Sox games, baseball camps for her children, weight loss services, and even to post bail for her prior criminal charges. In 2015 and 2018, Kasimatis was indicted by the Norfolk DA’s Office for public assistance fraud and larceny and pleaded guilty in Norfolk Superior Court in November 2020. She is currently on probation for those charges until November 2025.
All of these charges are allegations and defendants are presumed innocent until proven guilty.
The case is being prosecuted by Assistant Attorney General William Champlin, Senior Trial Counsel Elisha Willis, Senior Health Care Fraud Investigator Andrew Lutynski, and Investigators Derek Bottari and Vanessa Asiatidis of AG Healey’s Medicaid Fraud Division, with significant assistance from the Insurance Fraud Bureau, the U.S. Department of Health and Human Services, Office of the Inspector General, the Norfolk District Attorney’s Office, and MassHealth.
The AG’s 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.