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Massachusetts Medicaid Fraud Division Recovered $71 Million in 2022

November 15, 2022

According to a press release from Massachusetts Attorney General Maura Healey, the Medicaid Fraud Division recovered $71 million from fraudsters in the fiscal year ending in September 2022. The Massachusetts Medicaid Fraud Division investigates and prosecutes individuals who defraud MassHealth, the state’s Medicaid program.

Massachusetts Medicaid Fraud Division Settled 35 Cases

In fiscal year 2022, the Massachusetts Medicaid Fraud Division obtained settlements in 35 civil cases. The cases involved mental health services, skilled nursing facilities, home health agencies, and substance abuse treatments, among other things.   The settlements enabled the government to return a significant portion of the $71 million recovered to the MassHealth program. In addition, the Division criminally charged 24 individuals for fraud and/or the abuse, neglect, or exploitation of elders.

I’m proud of the important work our Medicaid Fraud Division does to ensure the integrity of our MassHealth system on behalf of taxpayers and MassHealth members.

-Massachusetts Attorney General Maura Healey

A $6 million resolution of allegations originally filed by our client is among the Division’s many successes.  In that case, a nationwide chain of opioid treatment centers and its owner paid $6 million to resolve allegations of medically unnecessary drug testing, improper referrals, and backdating prescriptions.

Attorney General’s Priorities in Fiscal Year 2022

As we reported earlier this year, cases involving harm to patients remains the top priority for state and federal government alike.  The Attorney General focused on cases involving nursing homes, home health agencies, and cases stemming from the opioid crisis.  The successes reported by the Massachusetts Attorney General include cases in all those areas. For example:

Mental Health Services: South Bay Mental Health Center, Inc.  paid $25 million to settle allegations that mental health services were provided to patients by unlicensed and unqualified staff members.

Safety of Elderly Patients: Five Massachusetts nursing homes settled claims that employees neglected residents and provided inadequate care which, in some cases, resulted in a patient’s death.

Home Health Care:  Four individuals were indicted for billing for services allegedly provided while they were working at other jobs.

Opioid Abuse:  A Marshfield pharmacy and its owner were criminally charged for accepting cash payments from MassHealth beneficiaries in return for prescribing opioids.

Whistleblower Law Collaborative

The Whistleblower Law Collaborative LLC, based in Boston, devotes its practice entirely to representing clients nationwide in bringing actions under the federal and state False Claims Acts.  Among the firm’s many recent successes is a $6 million settlement  for opioid treatment fraud and a $234 million settlement for Medicaid rebate fraud. Both of these cases resulted in recoveries benefitting Massachusetts taxpayers.

If you have evidence of fraud on government programs, contact us for a free and confidential consultation.

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