[MM Curator Summary]: Compassionate Homecare execs stole $6.5M from MA Medicaid with an un-authorized services scam.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
Compassionate Homecare Inc., has agreed to pay $6.53 million to MassHealth in order to resolve allegations of unauthorized billing for services.
The settlement irons out a 2018 lawsuit filed by the Attorney General’s office against Compassionate. The state’s lawsuit alleges that the company stole millions of dollars from MassHealth.
Aside from the $6.53 million settlement, $375,000 will be earmarked for payment of unpaid wages for former Compassionate employees.
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“This settlement is a victory for MassHealth and for workers who deserve to be paid back for missed wages,” Maura Healey, the attorney general of Massachusetts, said in a press release. “We will continue to protect the integrity of our MassHealth program and ensure compliance with our wage and hour laws.”
Compassionate owner, Francis Kimaru, pleaded guilty to separate criminal charges brought in by the Attorney General’s Medicaid Fraud Division in September 2019. Kimaru confessed to over-billing and falsely billing for services that were not authorized by a physician, or provided to patients.
The company also filed for bankruptcy in May 2020.
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OIG releases Medicaid fraud report
In addition to Massachusetts’ fraud news, the U.S. Department of Health and Human Services Office of Inspector General (OIG) recently released its latest Medicaid fraud report.
The report examines data from 2021 annual statistical reports that 53 Medicaid Fraud Control Units (MFCU) submitted to the OIG.
Overall, fraud convictions were about 70% of all 2021 convictions.
OIG saw an increase in total convictions resulting from MFCU cases, which went from 1,017 in 2020 to 1,105 in 2021. MFCU cases checked in at 780 convictions for fraud and 325 convictions for patient abuse or neglect.
Personal care workers and agencies had the highest number of fraud convictions each year from 2017 through 2021 compared to other types of providers.
In fact, there were 329 fraud convictions involving personal care workers and agencies, or 42% of the total 780 fraud convictions in 2021.
Personal care workers, or other home care aides, also made up a significant amount of the convictions for patient abuse or neglect. Specifically, workers in this sector accounted for 69, or 21%, of the total 325 convictions for patient abuse or neglect.
In total, MFCU criminal recoveries increased from $173 million in 2020 to $857 million in 2021. OIG credits cases prosecuted by MFCUs in Virginia and Texas for the increase in criminal recovery amounts.
In 2021, the OIG saw the total number of civil settlements and judgments decrease from 786 in 2020 to 716, though the pandemic may have resulted in skewed numbers.