Medical Fraud Division In Office Of AG Healey Recovers Millions From Health Providers Who Defrauded MassHealth

Attorney General Maura Healey.

HYANNIS – Attorney General Maura Healey recently announced that the office’s Medicaid Fraud Division reclaimed over $55 million in fraudulent medical earnings during the 2021 calendar year.

The Division investigates and prosecutes health care providers who defraud the state’s MassHealth Medicaid program, investigating cases of abuse and financial exploitation on behalf of MassHealth members and patients in long-term care facilities.

The Division secured 22 civil settlements originating from a range of health care workplaces including home health agencies, substance abuse treatment facilities, skilled nursing facilities and dental practices during the 2021 year.

Recovered funds were later returned to MassHealth, the Department of Public Health’s Long-Term Care Facility Quality Improvement Fund, out of pocket patients, federal Medicare program and whistleblowers who brought cases forward.

The largest settlement was resolved in October when South Bay Mental Health Center, Inc agreed to pay $25 million for allegedly submitting fraudulent claims to MassHealth for mental health services provided by unlicensed and unqualified staff at various statewide clinics.

The settlement was the largest of its kind in the nation.

“I’m proud of the vital work our Medicaid Fraud Division does to protect our most vulnerable residents, safeguard taxpayer dollars, and uphold the integrity of the MassHealth program,” said Healey.

“Addressing fraud and misconduct in the health care sector is a top priority for my office, and we will continue this important work in 2022,” she said.

The division receives three quarters of its funding through grants awarded by the U.S. Department of Health and Human Services, with the remainder being funded by the state.


By, Matthew Tomlinson, NewsCenter

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