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Two Massachusetts HomeCare Providers Will Pay Over $10 Million Over MassHealth Fraud Allegations

Avenue Homecare Services and Amigos Homecare will pay a total of $10.4 million to resolve allegations that they defrauded Massachusetts’ Medicaid program MassHealth.  

Two Massachusetts HomeCare Providers Will Pay Over $10 Million Over MassHealth Fraud Allegations

Dracut-based Avenue Homecare and Lawrence-based Amigos Homecare, two home health providers, are separate entities, and Attorney General Maura Healy is investigating them as such, though they allegedly incurred similar misconduct.  

As the settlement was announced, Healy wrote in a statement that, “[Avenue Homecare and Amigos Homecare] defrauded the state and diverted vital resources from elderly and disabled patients. Home health care companies must provide services that are medically necessary, follow MassHealth regulations, and keep accurate records to ensure the integrity of this program.”

The protocol for billing Masshealth for homecare services involves a certification of medical necessity by the responsible physician, including a plan of care. The government program also requires providers to keep records of services billed to the state for a minimum of six years.   

According to prosecutors, the two defendants repeatedly billed Masshealth for services “for which they did not have valid, signed plans of care.” In the case of Avenue, investigators found that the company submitted claims for payment for homecare services that could never have been provided, as the beneficiaries in question were being treated in the hospital during the same period.   

Amigos allegedly incurred the same type of misconduct. The complaint relates to wrongdoing taking place between 2014 and 2018 for Amigos and between 2013 and 2016 for Avenue. While many Medicaid fraud cases are referred to prosecutors by whistleblowers, in this case, it was MassHealth itself that uncovered the fraudulent conduct.

In an attempt to prevent future misconduct, MassHealth is implementing compliance programs for both providers. “Those programs will be implemented by an independent compliance monitor and will require Amigos and Avenue to establish updated policies and procedures governing compliance with federal and state requirements, to conduct annual training for all employees on those policies and procedures, and to perform annual audits to confirm that they remain in compliance with all applicable state and federal laws and regulations,” the Attorney General said in a statement.  

MassHealth has successfully prosecuted several unethical homecare providers over the last few years. In 2018, a Boston-based homecare provider was sentenced to prison for 36 months.

Multi-million-dollar settlements are not unusual in MassHealth fraud cases. Last February, a mental health center paid $4 million over False Claims Act violations.

If you know of a healthcare provider or company that is cheating its patients, call us. We can assist you in putting an end to the fraud and help you receive a large cash reward for your trouble. Connect with us 888.742.7248 or ONLINE.

[Is your information about another Massachusetts healthcare provider, visit our Massachusetts Medicaid fraud page for more information about whistleblower rewards.]

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