AG Healey reaches $10 million settlement with Lawrence home health care provider in fraud case

By Jeremy C. Fox, Globe Correspondent  | December 17, 2020

Attorney General Maura Healey’s office has reached a $10 million settlement with a Lawrence-based home health care firm that allegedly sent false claims to MassHealth, the state Medicaid program for low-income residents officials said Thursday.

Maestro-Connections Health Systems LLC and its chief executive, George Kiongera, allegedly billed MassHealth, without providing proper documentation from January 2014 to August 2019, Healey’s office said in a statement.

“Companies like Maestro that defraud MassHealth take vital resources away from the program and the people who need them most,” Healey said in the statement.

Since 2016, the attorney general’s office has recovered $40 million in payments to MassHealth, Healey said.

The agreement also blocks Maestro-Connections from providing services to MassHealth members until the company hires an outside monitor and undergoes a three-year compliance program — updating its policies, retraining staff, and cooperating with annual audits, according to the statement.

In Massachusetts, doctors must review and sign a plan of care confirming that home health services are necessary for medical reasons before MassHealth can be billed for such services, the AG’s office said. Home health care providers must hold onto those records for at least six years after services are provided and claims are filed.

Maestro-Connections, which has locations in Lawrence, Auburn, Athol, Framingham, Taunton, Holyoke, and Lynn, allegedly billed MassHealth for home health services without providing valid plans of care signed by doctors, Healey’s office said.

MassHealth found evidence of fraudulent billing by the company and notified the AG’s Medicaid Fraud Division, Assistant Secretary and Medicaid Director Dan Tsai said in the statement.

“Today’s outcome demonstrates the ongoing work between MassHealth and the Medicaid Fraud Division and MassHealth’s program integrity efforts to prevent inappropriate payments,” Tsai said.

The firm and Kiongera previously agreed in 2017 to $1 million-plus settlement for failing to keep accurate payroll records and not paying overtime to more than 600 home health aides, according to the statement.

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By Jeremy C. Fox, Globe Correspondent  | December 17, 2020

Attorney General Maura Healey’s office has reached a $10 million settlement with a Lawrence-based home health care firm that allegedly sent false claims to MassHealth, the state Medicaid program for low-income residents officials said Thursday.

Maestro-Connections Health Systems LLC and its chief executive, George Kiongera, allegedly billed MassHealth, without providing proper documentation from January 2014 to August 2019, Healey’s office said in a statement.

“Companies like Maestro that defraud MassHealth take vital resources away from the program and the people who need them most,” Healey said in the statement.

Since 2016, the attorney general’s office has recovered $40 million in payments to MassHealth, Healey said.

The agreement also blocks Maestro-Connections from providing services to MassHealth members until the company hires an outside monitor and undergoes a three-year compliance program — updating its policies, retraining staff, and cooperating with annual audits, according to the statement.

In Massachusetts, doctors must review and sign a plan of care confirming that home health services are necessary for medical reasons before MassHealth can be billed for such services, the AG’s office said. Home health care providers must hold onto those records for at least six years after services are provided and claims are filed.

Maestro-Connections, which has locations in Lawrence, Auburn, Athol, Framingham, Taunton, Holyoke, and Lynn, allegedly billed MassHealth for home health services without providing valid plans of care signed by doctors, Healey’s office said.

MassHealth found evidence of fraudulent billing by the company and notified the AG’s Medicaid Fraud Division, Assistant Secretary and Medicaid Director Dan Tsai said in the statement.

“Today’s outcome demonstrates the ongoing work between MassHealth and the Medicaid Fraud Division and MassHealth’s program integrity efforts to prevent inappropriate payments,” Tsai said.

The firm and Kiongera previously agreed in 2017 to $1 million-plus settlement for failing to keep accurate payroll records and not paying overtime to more than 600 home health aides, according to the statement.

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