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Alternative Headline: Randolph Provider Charged in $1M Fraud
[MM Curator Summary]: A Randolph autism service provider is accused of fraudulently billing over $1 million to MassHealth for unprovided ABA therapy services.
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The Massachusetts Attorney General’s Office has opened a new chapter in its ongoing mission to clamp down on health care fraud, indicting a Randolph autism service provider for falsely billing over $1 million. As detailed by the Attorney General’s announcement, Patrice Lamour and her two companies, Lamour by Design (LBD) and Lamour Community Health Institute (LCHI), face charges for their alleged misconduct. Specifically, the grand jury indicted the parties for one count of Medicaid False Claims and one count of Larceny over $1,200, according to Mass.gov.
The AG’s investigation stems from a referral by MassHealth after inconsistencies surfaced in billing practices. Services in question include Applied Behavioral Analysis (ABA), a key therapy for children with autism spectrum disorder, demanding oversight by licensed professionals. The problem, it seems, was that LBD claimed and was paid for certain supervision and family training services that could not have taken place due to staffing deficiencies — the only full-time Licensed Applied Behavioral Analyst (LABA) insisted he did not perform those services.
Allegations don’t stop there; both LBD and LCHI are accused of invoicing MassHealth for services on days when no services could have been provided, such as holidays or after patient cancellations. Moreover, staff were allegedly directed by Patrice Lamour to bill based on historical data and to falsify documentation to cover up the fraudulent activity.
It’s important to reiterate that these charges are just that — allegations. Patrice Lamour and her companies are presumed innocent until proven otherwise in court. Nevertheless, if the charges hold, this would not be the first instance of ABA providers facing justice. Earlier, the AGO secured a conviction against an Essex County man for stealing over $33,000 in MassHealth funds, and announced multi-million dollar settlements with other ABA providers for submitting fraudulent claims.
The encounter with such fraud is a sobering reminder of the cascading effects such actions can have on vulnerable populations like children with autism, who depend on these vital services. The Massachusetts Medicaid Fraud Division, bolstered by federal and state funding, is dedicated to unearth and prosecute such cases, safeguarding both the recipients of healthcare and the integrity of the healthcare system. They urge the public to report any suspected Medicaid fraud or instances of mistreatment in healthcare settings.