MM Curator summary:
MA homecare company (Maestro) stole $10M from Medicaid billing for services that had not been authorized by a physician.
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BOSTON — In ongoing efforts to combat fraud in the home health industry, Attorney General Maura Healey announced Friday that her office reached a $10 million settlement with a Lawrence-based home health care company and its owner to resolve allegations that they falsely billed the state’s Medicaid Program (MassHealth) for unauthorized services. The company, Maestro-Connections Health Systems, LLC, has an office in Athol.
Pursuant to a settlement agreement with the AG’s Office, Maestro and CEO George Kiongera will pay $10 million to resolve allegations that, from January 2014 through August 2019, they knowingly submitted false claims to MassHealth and MassHealth managed care entities for home health services that had not been appropriately authorized by a physician. Maestro has locations in Lawrence, Auburn, Athol, Framingham, Taunton, Holyoke, and Lynn.
“Companies like Maestro that defraud MassHealth take vital resources away from the program and the people who need them most,” said AG Healey. “Since 2016, my office has recovered $40 million for MassHealth by combating fraud, waste, and abuse in the home health industry. Our work continues to ensure health care dollars are spent appropriately.”
“MassHealth identified allegations of fraudulent billing by Maestro and referred the company to the Attorney General’s Medicaid Fraud Division,” said Assistant Secretary and Medicaid Director Dan Tsai. “Today’s outcome demonstrates the ongoing work between MassHealth and the Medicaid Fraud Division and MassHealth’s program integrity efforts to prevent inappropriate payments.”
“The submission of false claims to the MassHealth program drains resources from legitimate patient care,” said Phillip M. Coyne, Special Agent in Charge, Office of the Inspector General of the U.S. Department of Health and Human Service’s Boston Regional Office. “I appreciate the partnership with the Medicaid Fraud Division of the Massachusetts Attorney General’s Office in holding accountable those that seek to exploit this vital taxpayer-funded program.”
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 these records for at least six years after the medical services are provided and claims have been presented for payment. The AG’s Office alleges that Maestro billed for services for which it did not have valid, signed plans of care certifying that those services were medically necessary.
In addition to the financial payment, the settlement also includes a requirement that Maestro not resume providing services to MassHealth members until it has hired an independent compliance monitor to oversee a three-year compliance program. That program will include updated policies and procedures, new training for staff, and yearly audits conducted by the monitor.
In a November 2017 settlement with the AG’s Fair Labor Division, Maestro and Kiongera agreed to pay more than $1 million in restitution and penalties after failing to pay overtime to more than 600 home health aides and failing to keep accurate payroll records.
Today’s settlement is part of a larger effort by AG Healey and MassHealth to combat fraud in the home health industry.