[co-author: Alyssa Ferreone]

On April 30, 2019, the Office of the Attorney General of Massachusetts (AG) announced that it had entered into two settlements totaling over $10 million with home health care companies to resolve allegations of submission of false claims to MassHealth – the Commonwealth’s Medicaid program. The AG entered into a $8,305,300 settlement with Avenue Homecare Services of Dracut, and a $2.13 million settlement with Amigos Homecare of Lawrence, to resolve allegations that they billed MassHealth for unauthorized home health services.

The AG notes in its announcement that in order to bill MassHealth for home health services, a physician must review and sign a patient’s home health plan of care to certify the medical necessity of the home health services. According to the AG, each defendant submitted claims to MassHealth for home health care without having a signed physician certification for such services, in violation of MassHealth requirements. In certain instances, claims for home health services were allegedly submitted while patients were hospitalized. The AG further alleged that the companies failed to retain records of physician certifications in accordance with MassHealth regulations. In addition to securing a monetary payment, each company will be required to implement a multi-year compliance program overseen by an independent monitor in order to participate in MassHealth in the future.

The significant monetary penalties agreed to in these cases underscore the AG’s continued scrutiny of home health fraud affecting the MassHealth program, and follow criminal convictions obtained by the AG in prior cases. Post-acute care providers in Massachusetts would therefore be well-advised to review their compliance and recordkeeping policies, particularly if they participate in the MassHealth program.

This post was co-authored by Alyssa Ferreone, legal intern at Robinson+Cole. Alyssa is not yet admitted to practice law.

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