Two home health care firms settle AG’s fraud claims for $10M

By Jessica Bartlett | Boston Business Journal | April 30, 2019

Two home health companies will pay over $10 million in settlements to resolve allegations that they improperly billed the state’s Medicaid program.

According to Attorney General Maura Healey’s office, Amigos Homecare LLC of Lawrence will pay $2.13 million, and Avenue Homecare Services Inc. in Dracut will pay $8.3 million. The AG’s office said both companies submitted claims to MassHealth for home health care services that hadn’t been properly authorized by a physician.

“These companies defrauded the state and diverted vital resources from elderly and disabled patients,” Healey said in a release. “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 state said the companies submitted claims for members who were hospitalized at the time they allegedly received home care. Healey’s office said the claims occurred from June 2014 to April 2018 for Amigos, and from August 2013 to June 2016 for Avenue.

The state also said that neither company kept proper records to back up claims they had submitted to MassHealth. To receive home health services, a patient’s physician has to sign off on a plan of care certifying that such services are necessary.

In addition to the financial settlement, the companies will have to implement compliance programs in order to bill MassHealth in the future.

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By Jessica Bartlett | Boston Business Journal | April 30, 2019

Two home health companies will pay over $10 million in settlements to resolve allegations that they improperly billed the state’s Medicaid program.

According to Attorney General Maura Healey’s office, Amigos Homecare LLC of Lawrence will pay $2.13 million, and Avenue Homecare Services Inc. in Dracut will pay $8.3 million. The AG’s office said both companies submitted claims to MassHealth for home health care services that hadn’t been properly authorized by a physician.

“These companies defrauded the state and diverted vital resources from elderly and disabled patients,” Healey said in a release. “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 state said the companies submitted claims for members who were hospitalized at the time they allegedly received home care. Healey’s office said the claims occurred from June 2014 to April 2018 for Amigos, and from August 2013 to June 2016 for Avenue.

The state also said that neither company kept proper records to back up claims they had submitted to MassHealth. To receive home health services, a patient’s physician has to sign off on a plan of care certifying that such services are necessary.

In addition to the financial settlement, the companies will have to implement compliance programs in order to bill MassHealth in the future.

READ MORE