News  West Springfield Adult Day Health Company to Pay Nearly $275,000 to Resolve Allegations of Inappropriate Billing

Boston — An adult day health facility has agreed to pay nearly $275,000 to resolve allegations that it improperly billed the state’s Medicaid Program (MassHealth), Attorney General Maura Healey announced today.

Under the terms of a settlement agreement, Quality Life Adult Day Services (Quality), of West Springfield, will pay $274,809 to resolve allegations that it billed MassHealth for full-day adult day health services for members who did not attend the entire day. Quality will also implement a multi-year compliance program that will require annual training for all employees, as well as auditing, monitoring and reporting to the Attorney General’s Office.

“This company took away health care funds from those who need critical services by billing for more services than were actually provided,” said AG Healey. “I am pleased that this resolution will bring money back to MassHealth.”

During the relevant time period, when a MassHealth member attended the adult day health program for less than six hours a day, the provider was required to bill MassHealth using hourly, not daily, codes. The AG’s Office alleged that Quality billed for full day services, despite many of its patients not being there for full days. MassHealth will not reimburse adult day health providers for the portion of a program day during which a member is absent from the site, unless the program documents that the member was receiving services from program staff outside of the facility in a community setting. Quality cooperated with the Attorney General’s investigation into this matter.

The AG’s Office has resolved previous cases of improper billing at adult day health facilities. In November 2018, AG Healey secured settlements with three different adult day health facilities, recouping more than $500,000 for MassHealth. In 2016, the AG’s Office secured more than $200,000 for MassHealth from ADH Seller, LLC for allegedly billing for services not provided.

This matter was handled by Assistant Attorneys General Ali Russo, Jennifer Goldstein and Stephany Collamore and Investigator April Waterhouse of AG Healey’s Medicaid Fraud Division, with assistance from MassHealth.