Since 2016, the office of Attorney General Maura Healey has successfully prosecuted three home health agencies and their owners for defrauding MassHealth, the state's Medicaid program, and has settled civil actions against nine home health agencies similarly accused of improper billing.
During federal fiscal year 2020 alone, AG Healey's Medicaid Fraud Division recovered more than $45 million from companies and individuals participating in the MassHealth system, which provides health care coverage to approximately 23% of the Massachusetts populace.
In ongoing efforts in this vein, AG Healey announced this past Thursday that her office had reached a settlement with a Lawrence-based home health care company and its owner that resolved allegations of falsely billing MassHealth for services "not properly authorized by a physician."
The AG reported that Lifod Home Health Care LLC and the company's chief executive, Kariuki Kimungu, will pay $1.25 million to resolve allegations that, since May 1, 2015, "they knowingly submitted false claims to MassHealth and managed care entities administering services to MassHealth members for unauthorized home health" care.
"This kind of illegal conduct takes funds away from MassHealth, which provides critical health care to low-income and vulnerable residents across the state," said Healey. "We are committed to combatting fraud, waste, and abuse in the home health industry and will continue to take action against companies that don't abide by state laws and regulations."
To bill MassHealth for home health services, a provider must ensure that the member's physician has reviewed and signed a plan of care certifying that home health services are medically necessary. Home health agencies are required to maintain patient care records for at least six years after the medical services are provided and claims have been presented for payment. The AG's Office alleged that Lifod billed for services "for which it did not have valid, signed plans of care..."
In addition to the financial payment, the settlement also included a requirement that Lifod "...operate under a multi-year compliance program, overseen by an independent compliance reviewer. That program will include updated policies and procedures, new training for staff, and yearly audits conducted by the reviewer."
The AG maintains a broad focus to ensure that private entities doing business with the Commonwealth do not take advantage of the public purse.
This past Monday, for example, the AG's office announced that a consulting company doing business in multiple states reached a civil settlement of allegations that it had inflated bills on public works projects in Massachusetts, New York and New Jersey.
Under that settlement, V.J. Associates, Inc. of New England and an affiliated company, VJ Associates, agreed to pay back $1.8 million, with $195,871 going to Massachusetts.
A press release from the office stated that the investigation began after a whistleblower, a former employee of VJ Associates, filed a complaint under the Massachusetts False Claims Act, which allows individuals to file civil actions on behalf of the government and share in any recovered proceeds.
VJ Associates provided cost estimating and scheduling services as subcontractors on more than 100 public works projects throughout the Commonwealth.
AG Healey's investigation "revealed that VJ Associates was engaged in an overbilling scheme in which it would routinely inflate hours worked on projects paid on an hourly basis," the press release said. "Under pressure from management, employees openly discussed and described improper billing in emails as 'juicing' and 'tagging' hours in order to 'maximize' bills on government projects and not 'leave money on the table.' "
As part of this agreement, the AG reported, "VJ Associates admitted to submitting false bills and agreed to be debarred from submitting bids or being awarded any public works contracts with the Commonwealth of Massachusetts or any other government entity within the state for a period of five years."
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