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Thursday, January 28, 2021

AG SECURES MORE THAN $1 MILLION FROM TWO ADULT DAY HEALTH CENTERS OVER ALLEGATIONS OF IMPROPER BILLING

 AG SECURES MORE THAN $1 MILLION FROM TWO ADULT DAY HEALTH CENTERS OVER ALLEGATIONS OF IMPROPER BILLING

Facilities in Marlborough and Lowell Billed for Services Not Provided and in Violation of MassHealth Regulations

            BOSTON – Attorney General Maura Healey announced today that two adult day health centers in Marlborough and Lowell will pay more than $1 million to resolve allegations that they improperly billed the state’s Medicaid Program (MassHealth) for adult day health services.

            Fun Life Adult Day Care (Fun Life) in Marlborough and Monarch Elder Care (Monarch) in Lowell will pay $1,060,957.92 to resolve allegations that, since 2014, the companies improperly billed MassHealth for adult day health services that were not provided or that were in excess of permissible billing practices, in violation of MassHealth regulations. Both facilities are owned and operated by Malay Patel of Lowell.

            “False and improper billing to MassHealth takes away critical funds from a program that provides health care to some of our most underserved populations,” said AG Healey. “Companies must follow MassHealth billing regulations to ensure these critical resources are being allocated appropriately.”

“Today’s outcome is the result of MassHealth’s strong program integrity efforts to prevent inappropriate payments, and demonstrates the important partnership between MassHealth and the Medicaid Fraud Division to hold providers accountable for violating MassHealth regulations,” said Assistant Secretary for MassHealth and Medicaid Director Dan Tsai.​

            The AG’s Medicaid Fraud Division began investigating these two companies after referrals from MassHealth. The investigation found that, on numerous occasions, Fun Life and Monarch billed for more hours than members actually attended adult day health programs. The companies also improperly submitted claims in excess of per diem billing requirements. 

In addition to the financial settlement, both facilities have agreed to contract with an independent compliance monitor to oversee a three-year independent compliance program. The program will include updated policies and procedures on billing, new training for billing staff, and yearly audits conducted by the monitor, at Fun Life’s and Monarch’s expense. 

The AG’s Office has resolved previous cases of improper billing at adult day health facilities. In August 2020, the AG’s Office settled with two adult day health centers in Boston and Dartmouth for $186,000 to resolve allegations that they improperly billed MassHealth. In November 2019, AG Healey secured a settlement with an adult day health facility in Springfield, recouping nearly $275,000 for MassHealth for improper billing. In November 2018, three adult day health facilities agreed to pay more than $500,000 to settle allegations that they too engaged in improper billing.

This matter was handled by Managing Attorney Kevin Lownds, Assistant Attorney General Ali Russo, Senior Healthcare Fraud Investigator Aleksandra Andriyevskaya, and Investigator Johan Gonzalez, all of AG Healey’s Medicaid Fraud Division, with substantial assistance from MassHealth and the U.S. Department of Health and Human Services, Office of the Inspector General. The Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award. The remaining 25 percent is funded by the Commonwealth of Massachusetts.

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