| PHOTO: | Marylou Sudders, state secretary of Health and Human Services, whose department referred a dozen home health care agencies for investigation of potential fraud.PIC BY PAT GREENHOUSE/BOSTON GLOBE STAFF |
|
| |
|
|
By:
Priyanka Dayal McCluskey, Boston Globe Staff
|
| Posted:
Oct,07-2016 14:02:35
|
|
| |
|
A Worcester-based home health agency and three people involved with the company have been indicted by a grand jury for allegedly defrauding the state's Medicaid program of more than $800,000.
Compassionate Homecare Inc. provided nursing and other services for low-income patients on the government program known here as MassHealth. The agency is accused of conducting "numerous fraudulent schemes" and billing the state for providing services to patients who didn't need them, and for services that were never authorized by a doctor, in violation of rules.
"Our MassHealth program exists to assist people who are truly in need of health-related services, but this home health agency instead exploited this program to bilk hundreds of thousands of dollars from the state," Attorney General Maura Healey said in a statement.
Healey's office is bringing criminal charges in Worcester Superior Court against Compassionate and three executives: owner Francis Kimaru of Grafton; chief operating officer Wilberto Rodriguez of Norwich, Conn., and administrator Deborah Giordano of West Greenwich, R.I. They all were charged with larceny and making false Medicaid claims.
The charges are the culmination of an investigation that dates back several years and accelerated in December whenMassHealth officials took the unusual step of cutting off payments to the company. Compassionate responded by suing the state and going public with the dispute, saying it was quickly running out of money to operate. Most of its MassHealth members since have been transferred to other agencies.
The Attorney General's office said Compassionate altered documents to make it appear as if services were properly authorized by doctors. It allegedly "forged physicians' signatures in some cases after the physicians explicitly refused to authorize services," the attorney general's office added.
S. James Boumil, an attorney for Compassionate, said he could not comment in detail because he had not seen the charges. But he defended his client, calling Compassionate one of the best in the home-health business and said Kimaru, the owner, was not involved in any forgery of signatures. He said Kimaru has been open with investigators.
"Mr. Kimaru voluntarily discussed matters with the attorney general's office in hours of interviews. He never asserted the 5th Amendment in the investigation," Boumil said in a statement to the Globe.
The charges come after an investigation that began four years ago, after a complaint from a doctor who said Compassionate was trying to provide services through phony referral forms. It was one of the first investigations of its kind in Massachusetts, involving about 150 interviews and more than 100 boxes of paper records, the attorney general's office said.
MassHealth officials have referred several home health agencies to the attorney general for further investigation, but they rarely withhold payments from companies under investigation. In February,Kimarutold the Globe that without money from the state, he was laying off most of his workers and would have to stop serving hundreds of MassHealth patients.
At the time, Kimaru said he didn't know why the company was under investigation, adding: "We've done everything by the book."
Governor Charlie Baker's administration has been moving to cut state spending on home health, after a surge in costs in the past fiscal year. A recentauditby state officials found that nine companies overbilled the state by nearly $23 million. The companies cited in the audit are appealing those findings.
State officials also have strengthened authorization rules for home health services, and they have stopped doing business with new home health agencies.
Priyanka Dayal McCluskey can be reached atpriyanka.mccluskey@globe.com.Follow her on Twitter@priyanka_dayal.
|
|
Source:
|
|
.jpg)
RSS