NEW YORK – The Massachusetts Attorney General's Office said this week that the Suffolk County Statewide Grand Jury has indicted several MassHealth providers and their owners in an alleged laboratory fraud scheme.
MassHealth is the program overseeing Medicaid and the Children’s Health Insurance Program in Massachusetts.
According to the government, the providers submitted more than $7.8 million in false claims to MassHealth including for urine drug tests and home health services that were not provided, not medically necessary, and/or not properly authorized.
The Attorney General's Office (AGO) alleges that Worcester-based clinical lab Central Lab Partners (CLP), Danvers-based home health agency Patient Care Solutions (PCS), and Falmouth-based physician Maria Batilo operated a kickback scheme in which CLP and PCS submitted millions of dollars in false claims to MassHealth for urine drug tests and home health services.
CLP and PCS identified sober homes that wanted patients to receive urine drug monitoring and then enrolled those patients in urine drug testing and home health services that were not medically necessary under MassHealth requirements. Batilo allegedly authorized these home health services and drug test orders in exchange for payments from CLP and PCS even though she was not seeing or providing care to the patients. The AGO also alleges that many of the billed home health services were never actually provided.
CLP, its owner Cynthia Norton; PCS, and its owners Colette Massamba and Maxwell Dede; and Batilo were each charged with various counts of Medicaid false claims; larceny over $1,200; and Medicaid kickbacks. Massamba and Dede were also charged with one count each of money laundering.
The AGO also alleges that CLP and New Bedford-based clinical lab Optimum Labs engaged in a kickback scheme in which Optimum referred drug tests to CLP in exchange for a portion of the insurance reimbursement. CLP, Norton, Optimum, and its owner William Owens, were each charged with violating Medicaid kickback laws.
The AGO also alleges that Batilo illegally charged MassHealth patients cash, paid out of pocket, for the opioid addiction treatment Suboxone, despite the treatment being payable by MassHealth.
All of the aforementioned charges are allegations, and the defendants are presumed innocent until proven guilty, the AGO said.