Press Release  Quincy Woman Pleads Guilty, Sentenced to Prison for Fraudulent Billing Scheme for Behavioral Health Services Not Provided

BOSTON — A Quincy woman who owned a behavioral health clinic has pleaded guilty and been sentenced to serve three to four years in state prison in connection with a widespread fraudulent scheme to bill the state’s Medicaid program (MassHealth) and other private and government-funded insurance plans for behavioral health services that were never provided to patients or were improperly provided. 

Nicole Kasimatis, age 48, pleaded guilty yesterday in Norfolk Superior Court to the charges of Larceny over $1200 (3 counts), Filing a False Health Care Claim (2 counts), and Medicaid False Claims (2 counts). Following the plea, Judge Peter Krupp ordered her to three to four years in state prison followed by three years of probation with the conditions that she pay restitution, not work for a MassHealth provider and not bill MassHealth for services, remain in Massachusetts and forfeit any passports, and stay away from and have no contact with named witnesses. The restitution amount will be determined at a later date.  

“This defendant had a responsibility to provide patients with critical behavioral health services, but she instead chose to defraud the system for her own personal gain,” said AG Healey. “We are grateful to our partners in this case for working with us to hold this defendant accountable for her crimes and to protect our state resources from these schemes.”  

AG Healey’s Medicaid Fraud Division began an investigation into Kasimatis’ billing practices in 2019, following a referral from the Insurance Fraud Bureau (IFB) and the Norfolk District Attorney’s Office.  

“I referred the Medicaid fraud portion of this investigation to Attorney General Healey with confidence that the specialized prosecutors in her office could bring that matter to a just conclusion,” said Norfolk County District Attorney Michael Morrissey. “This is an example of the importance of good working relationships between law enforcement agencies.”    

“This is a result of a joint effort between the AG’s Office and the Insurance Fraud Bureau of Massachusetts,” said Anthony M. DiPaolo, Executive Director of the Insurance Fraud Bureau. “Today’s sentence shows that this activity is not tolerated in Massachusetts, and we will aggressively investigate this type of fraud.” 

“This provider took advantage of her access to patients for personal financial gain, undermining the integrity of federal health care programs and wasting valuable taxpayer dollars,” said Phillip Coyne, Special Agent in Charge with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG will continue to work tirelessly with our law enforcement partners to hold accountable perpetrators of health care fraud.” 

In November 2021, Kasimatis was arrested and arraigned for defrauding MassHealth of nearly $500,000 by billing for substance use disorder and/or mental health services she did not perform either because she was incarcerated or out of the country; billing for services not rendered by licensed or supervised Fortitude employees; and billing for services under the name and number of providers who no longer worked for Fortitude and who did not provide the services. In addition, Kasimatis obtained at least another $4,800 from private insurance companies for services not rendered.  

In January 2022, Kasimatis was arraigned on additional charges in connection with her billing scheme, by filing false Medicare claims for services not rendered and getting paid approximately $44,000.  

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.  

Following today’s change of plea, Kasmatis’ probation from previous cases was revoked, and she was also sentenced to two to three years in state prison to run concurrently with her three- to four-year prison sentence. 

This case was handled by Assistant Attorney General William Champlin, Senior Trial Counsel Elisha Willis, and Investigator Vanessa Asiatidis of AG Healey’s Medicaid Fraud Division, with significant assistance from the Insurance Fraud Bureau, the Norfolk District Attorney’s Office, the Office of Inspector General for the United States Department of Health and Human Services, the State Auditor’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. 

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