Two home health care companies operating in Massachusetts have reached settlement agreements that help to resolve allegations they had defrauded the state’s Medicaid program for a number of years. Improper billing is the main focal point surrounding the charges against Amigos Homecare LLC of Lawrence and Avenue Homecare Services Inc. in Dracut.
According to the state’s Attorney General, Amigos Homecare LLC has agreed to pay $2.13 million and Avenue Homecare Services Inc. will pay $8.3 million.
As reported by the Boston Business Journal in the news article, Two home health care firms settle AG’s fraud claims for $10M, written by Jessica Bartlett:
““These companies defrauded the state and diverted vital resources from elderly and disabled patients,” [Attorney General Maura] Healey said in a release. “Home health care companies must provide services that are medically necessary, follow MassHealth regulations, and keep accurate records to ensure the integrity of this program.”
The state said the companies submitted claims for members who were hospitalized at the time they allegedly received home care. Healey’s office said the claims occurred from June 2014 to April 2018 for Amigos, and from August 2013 to June 2016 for Avenue.”
Representatives for the state’s Attorney General also noted that neither company maintained adequate or proper records that would have helped them support claims for services provided that they had submitted to MassHealth. In order for Medicaid reimbursements through the state agency, a home care provider or company must maintain accurate records and the services provided must be signed off on a proper care plan by the patient’s physician. In these cases, those records were not adequately maintained and, therefore, there was no reasonable way to certify that the services provided were necessary.
On top of the financial agreement from each of these companies to repay the state, they’ve also agreed to implement compliance programs so when they bill MassHealth in the future, they will be done according to proper rules and regulations.
It is unclear whether these discrepancies or compliance issues were deliberate or unintentional. This settlement indicates that the state’s Attorney General’s office is satisfied and confident that these companies will be in compliance in the future.
Clients who had been relying on home care services provided by either one of these companies will continue to receive services as needed. It is unclear whether any disruptions in services had occurred as a result of the charges levied against either one.