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Home Healthcare Provider Pays $ 3.1 Million to Resolve Inappropriate Claims

Massachusetts-based home health care companies and their owners will pay millions of dollars to resolve allegations of false claims to the state’s Medicaid program, Mass Health.

The home care company is Altranais Home Care LLC in Lowell. Massachusetts Attorney General Maura Healey will pay a total of $ 3.1 million on Friday for the company and its owners Constant Ogut and Shakira Rubega to resolve allegations related to the medical need for services dating back to 2014. Was announced.

Specifically, there was an allegation that Altranais Home Care filed false claims with Mass Health and Mass Health’s managed care providers for home health services that were not properly licensed by doctors. According to the Attorney General, the provider did so “intentionally” or “recklessly ignoring billing requirements.”

“Home healthcare companies are obliged to provide only the services they need medically,” Healy said in a statement. “The company allegedly scammed MassHealth and improperly used resources that were lacking in services that doctors didn’t consider necessary.”

The settlement is part of a broader home health care enforcement effort in Massachusetts to combat fraud, waste and abuse.

In April 2019, Avenue and Amigos Home Care paid a total of $ 10 million to resolve similar false claims. In August 2019, Guardian Healthcare paid $ 1.95 million to resolve a similar allegation.

The jury also convicted the owner of a home health care facility in connection with other plans to scam Mass Health in May 2019 and August 2018.

Altranais Home Care provides skilled nursing, therapeutic and social services as part of its business mix. Both nurses, the company’s founders, expanded to the eastern, central, and western parts of the state after opening their first location in Tewkesbury, Massachusetts.

Financial reconciliation to resolve allegations related to the medical need for services is not uncommon in the industry. Such a settlement is also not a conviction by the provider.

Apart from its financial settlement, the Massachusetts Attorney General requires the Altranais Home Care to operate under a multi-year independent compliance program.

This program is carried out by an “independent compliance monitor”. You need to establish up-to-date policies and procedures that ensure compliance with federal and state law. In addition, the provider must provide annual training and annual audits for all employees. The results will be reported to the Attorney General’s office.

“Today’s results are the result of Mass Health’s strong program integrity efforts to prevent fraudulent claims and show the ongoing relationship between Mass Health and the Medicaid Fraud Division,” said Massachusetts Medicaid, Mass Health’s assistant secretary. Director Dan Tsai said in a statement.

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