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星期一, 10月 03, 2016

HOME HEALTH AGENCY CRIMINALLY CHARGED FOR DEFRAUDING STATE MEDICAID PROGRAM MORE THAN $800,000

HOME HEALTH AGENCY CRIMINALLY CHARGED FOR DEFRAUDING STATE MEDICAID PROGRAM MORE THAN $800,000
Defendants Allegedly Routinely Overbilled MassHealth, Falsely Billed for Unauthorized Services that Were Never Provided 

BOSTON – A Worcester-based home health agency and three individuals have been indicted in connection with allegations that they stole hundreds of thousands of dollars from the state’s Medicaid program (MassHealth) by routinely overbilling and falsely billing for services that were not authorized or provided to patients, Attorney General Maura Healey announced today.

“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,” AG Healey. “We will continue to aggressively pursue those who use fraudulent means and theft to pad their own pockets at the expense of patients and taxpayers.”   
                                                                                         
Compassionate Homecare, Inc. (CHC), owner Francis Kimaru, chief operating officer Wilberto Rodriguez, and administrator Deborah Giordano were indicted on Thursday by a Statewide Grand Jury on the following charges:

Compassionate Homecare
·         Larceny by False Pretense (4 counts)
·         Medicaid False Claims (5 counts)

Francis Kimaru, 41, North Grafton, MA
·         Larceny by False Pretense (1 counts)
·         Medicaid False Claims (2 counts)

Wilberto Rodriguez, 31, Norwich, CT
·         Larceny by False Pretense (2 counts)
·         Medicaid False Claims (3 counts)

Deborah Giordano, 57, West Greenwich, RI
·         Larceny by False Pretense (1 count)
·         Medicaid False Claims (2 counts)

The defendants will be arraigned in Worcester Superior Court at a later date.

CHC is headquartered in Worcester with branch offices in West Springfield and Lawrence. It was established to provide home health services to individuals covered by the MassHealth program, including skilled nursing and home health aide (HHA) visits.

The AG’s Office began an investigation after a physician complained that CHC was seeking authorization to provide services, through “phony” referral forms, for patients who had no medical need for home health services. MassHealth also referred the case to the AG’s Office after alleging misconduct. The AG’s investigation revealed that from 2011 to February 2016, CHC allegedly billed MassHealth through numerous fraudulent schemes.

Investigators allege that CHC recruited a significant number of patients who required no health-related services and who were fully capable of performing their own activities of daily living. 

The AG’s Office alleges that CHC, through Kimaru, Rodriguez and Giordano, routinely and knowingly billed MassHealth for services that had not been authorized by a physician in violation of MassHealth regulations.

The AG’s investigation also revealed that in several instances, CHC altered records on plans of care to omit notations by physicians denying home health services to make it appear as if services were authorized. In addition, CHC allegedly forged physicians’ signatures in some cases after the physicians explicitly refused to authorize services.

CHC also allegedly billed for services that it never provided to MassHealth members, including instances where the company billed for home health services while members were at inpatient facilities.

As a result of its investigation to date, the AG’s Office has identified $815,588.61 that MassHealth paid CHC for services that were either not authorized or never provided.           

MassHealth provides healthcare products and services to eligible low-income individuals, including people with disabilities, children and senior citizens.

All of these charges are allegations and defendants are presumed innocent until proven guilty.

               This matter was handled by Assistant Attorneys General Nita Klunder and Casey Groff, Investigators Gregoire Ucuz and Andrew Lutynski, all of AG Healey’s Medicaid Fraud Division, Special Agents from the
 Department of Health and Human Services Office of the Inspector General, and the AG’s Victim/Witness Services Division. The Massachusetts State Police and MassHealth assisted in this investigation.