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Massachusetts Attorney General Maura Healy
Attorney General Maura Healey’s Medicaid Fraud Division recovered more than $45 million for the state’s Medicaid program in 2017.
The division is responsible for the investigation and prosecution of fraud against the state’s Medicaid program, known as MassHealth. It recovered nearly $11 for every dollar appropriated in the 2017 fiscal year budget for its work.
“MassHealth provides critical health care services to many of our most vulnerable residents,” Healey said in a statement. “Our office works hard every day to stop fraud against the program, recover taxpayer dollars and make sure those funds are used properly to benefit our residents.”
The Medicaid Fraud Division pursued a variety of cases last year that resulted in substantial settlements from various entities, including pharmacies, doctors, home health companies and dental practices.
In addition to the civil settlements, three individuals were convicted in 2017 after the division brought criminal charges against them for defrauding MassHealth. An additional nine people were criminally charged in 2017 and their cases are currently pending.
Fighting the Opioid Epidemic
The division prioritized cases involving providers who contribute to the opioid epidemic by illegally prescribing or dispensing pills. The AG’s office reached a settlement with Walgreens over its improper dispensing of controlled substances that resulted in an additional $200,000 to the AG’s Youth Opioid Prevention grant program. The settlement also requires Walgreens, similar to a previous settlement with CVS in 2016, to strengthen its policies and procedures around the dispensing of opioids and requires its Massachusetts pharmacy staff to check the state’s Prescription Monitoring Program before filling prescriptions for commonly misused opioids.
A Dorchester doctor, Dr. Ashok Patel, was indicted in connection with charging patients cash for opioid addiction treatment already covered by MassHealth and illegally profiting off of vulnerable patients in Massachusetts. In May, another doctor, Dr. Fernando Jayma, was sentenced to two and a half years in jail for illegally prescribing opioids to patients for no legitimate medical purpose, some of whom had documented substance use disorder.
The division has also focused on combating fraud, waste and abuse in the home health industry. In the largest settlement with a home health company in Massachusetts, Centrus Premier Home Care Inc. and Maxim Healthcare Services Inc. agreed to pay more than $14 million to settle allegations that it improperly submitted claims and received overpayments for services from MassHealth after a voluntary provider overpayment disclosure. Apria Healthcare, a nationwide provider of home healthcare products, in August paid more than $750,000 for directly billing people for services already covered by MassHealth, a payment that includes refunds to hundreds of affected MassHealth members.
Healey criminally charged multiple individuals for false billing schemes. Hellen Kiago and her company, Lifestream Healthcare Alliance, were indicted in October for allegedly stealing $2.7 million from MassHealth by routinely overbilling and falsely billing for services that were not authorized. Harmony Home Health Care owner Elena Kurbatzky and an employee were charged in July in connection with allegedly stealing nearly $2.7 million from MassHealth by falsely billing for services that were not authorized or provided to patients.
The AG’s office also works to maintain a leadership position nationally in the fight against fraud, waste and abuse in the Medicaid program. The $45 million recovered in 2017 is primarily the result of 24 civil settlements, 14 of which were multistate agreements.
Representatives from the AG’s Medicaid Fraud Division serve on national multistate fraud teams that negotiate the resolution of these cases, which in 2017 resulted in the return of $580 million to the federal government and state Medicaid programs across the country.
Pharmaceutical company Mylan paid $20.3 million to MassHealth in October as part of a multistate settlement to resolve allegations that it knowingly underpaid rebates owed to the Medicaid program for EpiPens dispensed to MassHealth members.
