Massachusetts Home Health Facilities Pay Out $14M for False Claims

False Claims Act , Healthcare Fraud

A multi-facility home healthcare chain has reached a $14 million settlement to resolve claims which assert their role in a large-scale scheme to defraud MassHealth, Massachusetts’s Medicaid program. From 2010 to 2016, Centrus Premium Home Care Inc. was found to have submitted an array of improper claims regarding medically unnecessary services that are not covered by the state-funded program.

Centrus, which operates in Massachusetts under Maxim Healthcare Services Inc., operates six locations across the state; through these facilities, the company fraudulently billed MassHealth and received payment for nearly 95,000 treatments and services that were not covered under the program’s regulations.

In an unusual and somewhat reassuring twist, this case was brought to the attorney general’s office by none other than Maxim itself. Upon discovering that there had been a “misinterpretation” of one of the program’s regulations regarding nursing and skilled therapy services, Maxim voluntarily disclosed its overpayment to MassHealth, who brought forward the case to the attorney general’s Medicaid Fraud Division.

The CEO of Maxim, Bill Butz, publicly apologized in a statement, going on to further remark, “Maxim is deeply committed to maintaining a strong culture of compliance and integrity and we take our obligations to MassHealth and the other programs we serve very seriously. While we regret this error, we are pleased we were able to identify it on our own and take the necessary steps to resolve it quickly.”

In an effort to resolve the fraudulent claims that had been submitted, Maxim agreed to pay $14.2 million; additionally, they are entering into a three-year compliance agreement, in which they must annually report in writing to state officials to ensure that they are abiding by federal and state regulations as pertaining to Medicaid. Even further, they must provide extensive training as it pertains to MassHealth billing statutes in an effort to prevent further billing mishaps.

Though any type of fraud will always qualify as criminal activity, it is certainly a refreshing change of pace to witness a home healthcare facility so dedicated to the pursuit of honesty that they will bring themselves forward and take accountability for their wrongdoings, regardless of the cost. So often, fraud victimizes the residents of home health agencies in ways that truly induce suffering to the patients themselves; thankfully, this case strays from the unfortunate norm and steps more closely towards what we at WJN strive for – transparency and integrity in the healthcare world.

Whistleblower Justice Network Can Help You

Whistleblower Justice Network partners with whistleblowers to bring those who knowingly defraud the Medicaid program to justice. Under the qui tam provisions of the False Claims Act, we assist individuals who bring forth information about fraudulent schemes in filing cases against those bilk the healthcare system for personal gain.

If you have meaningful information regarding home health fraud that you believe is in violation of the False Claims Act, Whistleblower Justice Network can help. Working alongside world-class legal counsel, we will ensure you are protected to the fullest extent of the law and that you receive credit for the information you bring to the U.S. government. Partnering with whistleblowers is all we do. Visit us at www.whistleblowerjustice.net, or call us at 844-WJN-4ALL.

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