[co-author: Stephanie Kozol]*
The Office of Massachusetts Attorney General (AG) Andrea Campbell announced the criminal indictment of several Massachusetts-based health care providers and their owners in connection with allegedly false claims they submitted to the Massachusetts Medicaid program, MassHealth. In what Campbell characterized as a fraud and kickback arrangement, the defendants submitted more than $7.8 million in false claims for reimbursement associated with urine drug tests and home health services that were not provided, not medically necessary, or not properly authorized.
According to a statement from Campbell’s office, a grand jury in Boston returned indictments against several MassHealth providers and their respective owners. The Massachusetts grand jury returned indictments for the following entities:
- Central Lab Partners, LLC (CLP), a Worcester-based clinical laboratory;
- Cynthia Norton of West Boylston, the owner of CLP;
- Patient Care Solutions, LLC (PCS), a Danvers-based home health agency;
- Colette Massamba and Maxwell Dede of Lynn, the owners of PCS;
- Optimum Labs, Inc. (Optimum), a New-Bedford-based clinical laboratory;
- William Owens of New Bedford, the owner of Optimum; and
- Maria Batilo, a Falmouth-based physician.
The criminal matter will proceed in Suffolk Superior Court in Boston.
Massachusetts alleges that CLP and PCS targeted sober homes that conducted frequent urine drug tests for sobriety monitoring purposes, and then enrolled those patients in urine drug tests and home health services under MassHealth, even though the sobriety-monitoring urine tests were not reimbursable under MassHealth because they were not medically necessary (i.e., not ordered by a medical professional) as required.
Separately, Massachusetts alleges that CLP engaged in a kickback scheme with Optimum pursuant to which Optimum referred drug tests to CLP in exchange for a portion of related insurance reimbursements. The state also alleges that Batilo illegally required MassHealth patients to pay for Suboxone, an opioid addiction treatment, with cash even though the treatment is payable by MassHealth.
Why It Matters
The Massachusetts indictments underline the importance of understanding the requirements for reimbursement of covered services under state health care systems when public funds are involved. Submission of claims for payment for services provided in association with violations of state regulatory requirements may result in substantial civil or criminal liability. Campbell’s indictment serves as a reminder that even the owners may be individually liable for alleged misconduct of their companies when it comes to purported fraudulent schemes and kickback violations.
*Senior Government Relations Manager
