Massachusetts Medicaid Fraud Division recovers millions in fraud

BOSTON – Attorney General Maura Healey announced today that her Medicaid Fraud Division recovered more than $46 million for the state’s Medicaid program (MassHealth) in 2019.

The AG’s Medicaid Fraud Division investigates and prosecutes those who defraud the MassHealth program. The Division is also responsible for reviewing complaints of abuse, neglect, mistreatment, and financial exploitation of patients in long-term care facilities. The Division recovered more than 10 dollars for every dollar appropriated in 2019 for its work.

In 2019, the Division secured 30 civil settlements with various entities, including major pharmacy chains, home health agencies, nursing homes, and individual doctors and practices. Twelve individuals and entities were criminally convicted on charges in connection with Medicaid Fraud schemes, and an additional five providers were criminally charged for defrauding MassHealth.

“Our Medicaid Fraud Division is one of the most active and nationally respected units in the country,” said AG Healey. “From protecting patients in our nursing home facilities, to returning tens of millions of dollars to the program every year, MFD supports the integrity of MassHealth and makes sure that our state’s most vulnerable get the care they need.”

In 2019, the Division continued to focus on combatting fraud in the home health care industry. In April 2019, AG Healey announced settlements with Amigos Homecare LLC and Avenue Homecare Services LLC, recovering more than $10 million to MassHealth. In May, a jury convicted Hellen Kiago, the former owner of Lifestream Healthcare Alliance, on five counts in connection with a scheme to steal millions from MassHealth. Kiago is currently serving time in jail. Guardian Healthcare LCC paid $1.95 million in August 2019 to resolve allegations that it improperly billed MassHealth for home health services that had not been authorized by a physician. In September 2019, Francis Kimaru, owner of Compassionate Homecare, Inc., and his company pled guilty to three counts in connection with a home health Medicaid Fraud scheme worth hundreds of thousands of dollars. The office also secured the indictment of a Chelmsford couple in December 2019 in connection with a scheme to exploit homeless individuals in order to make fraudulent home health claims to MassHealth.

Prosecutors in the Division secured the guilty plea of Michael Davini, the owner of Rite Way LLC, a company that provided transportation services to MassHealth members. Davini pleaded guilty in October on charges in connection with a scheme to steal millions from MassHealth by submitting fraudulent claims for wheelchair transportation services that were never provided. Davini was sentenced to jail and returned $4.2 million to MassHealth.

Safety throughout Massachusetts nursing homes remained a priority for the Division. In March 2019, the AG’s Office concluded investigations into seven separate nursing home facilities across Massachusetts. The resulting settlements returned hundreds of thousands of dollars to the state, resolved significant, systemic violations that endangered residents, and required ongoing compliance monitoring at these facilities to protect residents from future harm.

The Division supported the office in combating the opioid epidemic by holding large pharmacy companies and physicians accountable for their prescribing practices. In January 2019, Rite Aid of Massachusetts agreed to pay $177,000 to the state’s Naloxone Fund and correct its opioid dispensing procedures for MassHealth members. Reckitt Benckiser, a large pharmaceutical company that makes Suboxone, a commonly used treatment for opioid use disorder, paid nearly $19 million to the state for knowingly promoting the sale and use of a specific kind of Suboxone treatment based on false and misleading information. In January 2019, a Dorchester doctor, Ashok Patel, pled guilty in connection with charging patients cash for suboxone treatment already covered by MassHealth. He was sentenced to house arrest and required to surrender his medical license.