BOSTON – Continuing her commitment to rooting out fraud in state programs and recovering taxpayer dollars, Attorney General Maura Healey today, January 30 announced that her Medicaid Fraud Division recovered more than $45 million for the state’s Medicaid program in 2017.
The AG’s Medicaid Fraud Division is responsible for the investigation and prosecution of fraud against the state’s Medicaid program, known as MassHealth. The Division 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 media 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.”
In 2017, AG Healey’s Medicaid Fraud Division pursued a variety of cases for Massachusetts that achieved 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 Medicaid Fraud Division brought criminal charges against them for defrauding MassHealth. An additional nine people were criminally charged in 2017 and their cases are currently pending.
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.
In criminal cases reflecting AG Healey’s focus on fighting the opioid epidemic, 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. d/b/a/ 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. In August, Apria Healthcare, a nationwide provider of home healthcare products, 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.
In her continued efforts to address fraud in the home health industry, AHealey criminally charged multiple individuals for false billing schemes. In October, Hellen Kiago and her company, Lifestream Healthcare Alliance, were indicted for allegedly stealing $2.7 million from MassHealth by routinely overbilling and falsely billing for services that were not authorized. In July, Harmony Home Health Care, owner Elena Kurbatzky and an employee were charged in connection with allegedly stealing nearly $2.7 million from MassHealth by falsely billing for services that were not authorized or provided to patients.
AG Healey’s Office also continues 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 Attorney General’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.
In October, as part of a multistate settlement, pharmaceutical company Mylan paid $20.3 million to MassHealth to resolve allegations that it knowingly underpaid rebates owed to the Medicaid program for EpiPens dispensed to MassHealth members.
Medicaid is a multi-billion-dollar joint state and federal program that provides health insurance for the economically disadvantaged. The Medicaid Fraud Division works cooperatively with MassHealth and other state and federal agencies to prosecute provider fraud in the Massachusetts Medicaid program. Many of the cases handled by the AG’s Office were referred by MassHealth.