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星期二, 7月 11, 2017

OWNER OF HOME HEALTH AGENCY AND EMPLOYEE ARRESTED FOR ALLEGEDLY STEALING NEARLY $2.7 MILLION FROM MASSHEALTH

OWNER OF HOME HEALTH AGENCY AND EMPLOYEE ARRESTED FOR ALLEGEDLY STEALING NEARLY $2.7 MILLION FROM MASSHEALTH
Defendants Charged with Routinely Overbilling MassHealth, Falsely Billing for Unauthorized Services that Were Never Provided 

BOSTON – The owner of a Boston-based home health agency and an employee have been arrested in connection with allegedly stealing nearly $2.7 million 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.

Elena Kurbatzky, age 44, of Boston, and Natan Zalyapin, age 43, of Burlington, were arrested last night by Massachusetts State Police assigned to the AG’s Office. A Suffolk County Grand Jury returned indictments charging Kurbatzky, Zalyapin and the company, Harmony Home Health Care, LLC (Harmony), on Monday.
“We allege that these defendants stole millions of MassHealth funds meant to provide health care for those in need,” said AG Healey. “My office is committed to protecting Medicaid from fraud and abuse.”

Kurbatzky was indicted on charges of Medicaid False Claims (3 counts), Larceny over $250 by False Pretenses (3 counts), and Medicaid Member Eligibility Fraud (1 count). Zalyapin was indicted on charges of Medicaid False Claims (2 counts) and Larceny over $250 by False Pretenses (2 counts). Harmony was indicted on charges of Medicaid False Claims (3 counts) and Larceny over $250 by False Pretenses (3 counts).

Kurbatzky and Zalyapin were arraigned in Suffolk Superior Court today where they pleaded not guilty to the charges. Zalyapin was released on personal recognizance and Kurbatzky was transferred to Boston Municipal Court on an outstanding warrant.

As conditions of their release, they must surrender their passports, be monitored by GPS, not travel outside of the state, check in weekly with the Probation Department, stay away from witnesses in the case, and not provide or bill for MassHealth services. They are scheduled to appear in Suffolk Superior Court for a hearing on Aug. 8. 

The company will be arraigned in Suffolk Superior Court on Aug. 8.

Harmony is a home health agency located on Albany Street in Boston and Kurbatzky is the sole owner. The agency was established to provide home health services to individuals covered by the MassHealth program, including skilled nursing, home health aide visits and physical, occupational, and speech therapies. Kurbatzky and Zalyapin are both registered nurses and allegedly provided the majority of nursing services to Harmony’s patients.

The AG’s Office began an investigation after the matter was referred by MassHealth, which suspected misconduct and fraudulent billing practices.

The AG’s investigation revealed that between February 2015 and October 2016, Harmony billed MassHealth for home health services allegedly provided to 38 patients, but either provided no services to those patients or billed for more services than were actually provided.

Specifically, authorities allege that on numerous instances, Harmony billed MassHealth for nurses who allegedly provided services to several patients in different locations at the exact same time, so those services could not physically have been performed as claimed.

The defendants also billed MassHealth for services that were not authorized by physicians and, in many cases, forged physician signatures on the patient plans of care in an attempt to show the services were authorized.

The defendants allegedly billed for services never provided to MassHealth members, including instances where the company billed for home health services while members were at inpatient facilities. Kurbatzky and Zalyapin also billed MassHealth for services that were not provided while they were traveling or while Zalyapin was working at other jobs. 

The defendants billed for physical, occupational, and speech therapy for the majority of Harmony’s MassHealth patients even though the services were not authorized by the patients’ physicians and Harmony did not employ licensed therapists to perform the alleged services.

Kurbatzky also allegedly made false statements or failed to disclose material facts in order to make herself eligible for MassHealth. She then allegedly billed MassHealth for services she purportedly received from Harmony that were not authorized by a physician. 

Based on these various schemes, the AG’s Office alleges that the defendants defrauded MassHealth of nearly $2.7 million dollars.

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 Jennifer Goldstein and Kevin Lownds and Investigators Christine Baker and Megan Corrigan, all of AG Healey’s Medicaid Fraud Division, with assistance from the Massachusetts State Police assigned to the AG’s Office, Victim Witness Advocate Amber Anderson, of the AG’s Victim Services Division, and the Office of the Inspector General. MassHealth provided invaluable assistance during this investigation.