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Home Health Medicaid Fraud Cases Announced by Massachusetts AG

November 22, 2021

Massachusetts Attorney General Maura Healey has continued to crack down on home health Medicaid fraud.

AG Announces Two New Home Health Medicaid Fraud Matters

First, the AG’s Medicaid Fraud inked a $1.2 million settlement with a home health group and its owners.  The AG accused the group, Independent at Home, of seeking payment for services that were not properly authorized by a physician.  In addition, Independent allegedly submitted bills for services that it did not provide.  According to the AG, Independent’s two owners knew that the company had received improper payments.  However, they did not notify MassHealth or return any money.

AG Healey emphasized the significance of the settlement: “This company’s years of false billing has taken away state resources from the people who need it most.  We will continue our work to hold bad actors in the home health industry accountable for fraudulent behavior and are proud to have brought back millions to Massachusetts as a result of our investigations.”

Second, the AG’s office filed a complaint against Prestige Health Care Services and its executives.  In this suit, the government alleges that the agency cheated MassHealth out of at least $7 million.   As with Independent, the AG alleges that Prestige billed for services that were not authorized by a physician.   According to the complaint, employees raised concerns with both executives about billing MassHealth without physician-authorization, but no changes were made to the company’s practices.  Notably, the AG filed its lawsuit via the Massachusetts False Claims Act.  (For another Massachusetts False Claims Act suit filed by the Attorney General’s office, look here.)

The Larger Effort to Stop Fraud in the Home Health Industry

This settlement is part of a larger effort by AG Healey and MassHealth to combat home health Medicaid fraud.  Since 2016, the AG’s office has successfully prosecuted three home health agencies and their owners and settled civilly with ten home health agencies.  This effort has returned more than $42 million to MassHealth.

This effort parallels federal actions against home health agencies cheating the Medicare system.

Unfortunately, fraud has taken root in many parts of the home health industry and other provider services.  You can read more about health care fraud, including home health schemes, here. If you have information about possible health care fraud, please contact us for a free consultation.  We have the expertise and desire to help.

 

 

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