A Newton physician will pay $680,000 in restitution and penalties and has agreed to be subject to a comprehensive compliance program to resolve allegations that his office routinely overbilled the state’s Medicaid program (MassHealth) for services at nursing homes, Attorney General Maura Healey announced Thursday in a press release.
Hooshang Poor, a geriatric physician from Newton, has resolved allegations that from June 2011 through May 2017, he fraudulently billed MassHealth for non-emergency visits to nursing homes that exceed the limit of visits per month under MassHealth regulations, according to the DA. The settlement also resolves allegations that Dr. Poor submitted claims to MassHealth and Medicare that overstated the length, extent, and scope of services he and his employees provided to nursing home residents.
“This doctor stole hundreds of thousands of dollars from MassHealth – taking away health care resources for those who are most in need,” said Healey. “We will continue to take action to defend the integrity of MassHealth and protect Massachusetts residents.”
Under the terms of the agreement with the AG’s Office and the U.S. Attorney’s Office, Dr. Poor will pay a total of $680,000 in restitution and penalties to MassHealth and Medicare. Poor has also agreed to be subject to a comprehensive compliance program implemented and overseen by an independent compliance monitor. This program will require Poor to update policies, procedures, and employee trainings to address his coding and billing practices, and will further require annual on-site audits of Poor’s compliance with state and federal laws for the next three years.
This case is being handled by Assistant Attorneys General Gregory Matthews and Kevin Lownds and Investigators April Waterhouse and Megan Corrigan, all of the AG’s Medicaid Fraud Division. Assistant United States Attorney David Derusha of the U.S. Attorney’s Office of Massachusetts, the U.S. Department of Health and Human Services Office of the Inspector General, the State Auditor’s Office, and MassHealth provided critical support to this investigation. This matter was referred to the AG’s Office by MassHealth.