BOSTON - Attorney General Maura Healey announced today that her Medicaid Fraud Division recovered more than $45 million for the state’s Medicaid program (MassHealth) in state fiscal year 2018.
The AG’s Medicaid Fraud Division investigates and prosecutes those who defraud the MassHealth program. The Division is also responsible for reviewing complaints of abuse, neglect, mistreatment and financial exploitation of patients in long-term care facilities. The Division recovered approximately $11 for every dollar appropriated in the 2018 fiscal year budget for its work.
“Our Medicaid Fraud Division works every day to protect the integrity of MassHealth and ensure that its funds are used appropriately to support our most vulnerable residents,” said AG Healey. “Each year, we recover millions of dollars for taxpayers and help ensure that residents are getting quality medical care.”
In fiscal year 2018, the AG’s Medicaid Fraud Division secured 18 civil settlements with various entities, include major pharmacy chains, home health agencies, and doctors. Three individuals were convicted on charges in connection to Medicaid Fraud schemes, and an additional 11 people were criminally charged for defrauding MassHealth.
Dental practices remained a focus of the Division during fiscal year 2018. In January 2018, Kool Smiles settled for $1.7 million to resolve allegations that the practice performed medically unnecessary dental work on children. The Division also reached settlements with Dental Dreams, LLC for more than $1.3 million, which was alleged to have billed MassHealth for unnecessary procedures, and dentist Annie Watson for $500,000, who was alleged to have improperly billed MassHealth for palliative care. In August 2018, Dazzling Smile and Dr. Shahrhzad Haghayegh-Askarian were indicted on charges that they developed a scheme to fraudulently bill MassHealth under another dentist’s name.
The Division also continued to focus on combatting fraud in the Massachusetts home health care and the personal care attendant industries. In August 2018, after a seven-day trial, a jury convicted Elena Kurbatzky, the owner of a Boston home health care agency, on seven counts in connection with a scheme to steal millions from MassHealth. In November 2018, personal care attendant Theodore Gilbert and surrogate Madeline Garcia Gilbert pleaded guilty to charges that they billed MassHealth for services after the patient had died.
In its efforts to enforce regulatory requirements for pharmaceutical providers, the Division secured $20.3 million from pharmaceutical company Mylan in an October 2017 national settlement to resolve allegations that it knowingly underpaid rebates owed to the Massachusetts Medicaid program. In December 2018, Target Corp. agreed to pay $3 million to resolve allegations that it improperly operated an automatic refill program at its Massachusetts locations. In February 2019, the Division resolved allegations that Walgreens had overcharged MassHealth members more than $2 million for prescriptions..
The Medicaid Fraud Division continues to focus on combatting the opioid epidemic and since the end of fiscal year 2018 has resolved several cases and taken action to that end. A Dorchester doctor, Ashok Patel, recently pleaded guilty in connection with charging patients cash for suboxone treatment already covered by MassHealth. He was sentenced to house arrest and surrendered his medical license. In August 2018, the Division secured a settlement with the North-Andover based Center for Psychiatric Medicine for illegally charging cash for suboxone. In December 2018, a Dracut physician was charged with 47 criminal counts related to illegal prescribing and MassHealth fraud, including the state’s first involuntary manslaughter charge related to opioid prescribing.
The Division has a national presence within the National Association of Medicaid Fraud Control Units (NAMFCU). Assistant Attorneys General and Investigators presented at the annual conference and act as facilitators at NAMFCU trainings. The Division regularly plays a leadership role in national initiatives and in multi-state false claims cases.
Medicaid is a multi-billion-dollar joint state and federal program that provides health insurance for the economically disadvantaged. The Division works cooperatively with MassHealth and other state and federal agencies to prosecute provider fraud in the Massachusetts Medicaid program. Many of the cases handled by the AG’s Office were referred by MassHealth.