Since taking office in January 2015, Massachusetts Attorney General Maura Healey has aggressively, and successfully, tackled healthcare fraud in the state, pursuing pharmacies, home healthcare entities, urgent care facilities, labs and others that have defrauded the Massachusetts Medicaid program, known as MassHealth. Over the course of fiscal year 2018, the Medicaid Fraud Division of the Attorney General’s office recovered more than $45 million through 18 civil settlements. 

In her latest victory, the AG’s office engineered a settlement with BioScrip Pharmacy, a Colorado-based pharmacy that is alleged to have unlawfully auto-filled prescriptions between 2009 and 2012. Massachusetts law forbids the automatic refill of prescriptions without specific requests from either the patient or the prescriber. Bioscrip agreed to pay $1 million to settle the claims.

The Bioscrip settlement follows several other prescription autofill settlements in recent months:

  • Target settled with Massachusetts and the federal government for $3 million in December 2018
  • PharmaHealth settled similar claims for $360,000 in August 2018

The Attorney General has taken aim at other health care entities that have engaged in fraudulent activity as well.

Pharmaceutical Companies

Pharmaceutical giant Mylan settled with the state for $20.3 million in an October 2017 national settlement to resolve allegations that it knowingly underpaid rebates owed to the Massachusetts Medicaid program. 

Home Health Care

In late April, Amigos Homecare, LLC and Avenue Homecare Services Inc. agreed to pay more than $10 million (just over $2 million from Amigos and over $8 million from Avenue) to resolve allegations that the two companies submitted false claims to MassHealth. In both cases the AG’s office alleges that the companies billed for services for which they did not have valid, signed care plans. 

In 2018, a jury convicted Elena Kurbatzky, the owner of a Boston home health care agency, in connection with a scheme to steal millions from MassHealth. In November of that year, Theodore Gilbert and Madeline Garcia Gilbert pleaded guilty to charges that they billed MassHealth for services after the patient had died.

Dental Practices

The AG’s office caught several dental practices in the commission of fraudulent acts during 2018.

Settlements included Kool Smiles ($1.7 million) to resolve allegations that the practice performed medically unnecessary dental work on children; Dental Dreams, LLC ($1.3 million) for unnecessary procedures; 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; and dentist Annie Watson for $500,000, for allegations that she had improperly billed MassHealth for palliative care. 

Urgent Care

In March, the AG’s office announced that CareWell Urgent Care Centers would pay a combined $2 million to Massachusetts, Rhode Island and the federal government following allegations that it had “routinely’ overbilled MassHealth and other plans. Allegations include the administration of unneeded exams, the alteration of billing records and submitting bills for reimbursement at physician rates when services had in fact been provided by nurse practitioners or others who were reimbursed at a lower rate by the plans.

Laboratories

The Center for Human Genetics, Inc., a Cambridge-based lab, agreed to pay $500,000 for allegedly submitting multiple incorrect billing codes for genetic tests and improperly billing MassHealth for hundreds of thousands of dollars.