[Updated] Guardian Healthcare Resolves Improper Billing Allegations; Home Health Recruiter Found Guilty in Medicaid Kickback Scheme

Guardian Healthcare resolves allegations

Boston-based Guardian Healthcare has entered into a financial settlement with MassHealth, the Massachusetts Medicaid program, according to Law360. 

The home-based care provider — which offers home health and home care services — agreed to pay $1.95 million to resolve allegations that it submitted Medicaid claims without physician authorization that the services were “medically necessary.”

In addition to the settlement, Guardian will participate in a compliance program for three years, Law360 reported. During that time, the provider must submit annual notes and partake in additional staff training, among other requirements. 

“Home health care companies provide important services to people all across Massachusetts,” State Attorney General Maura Healey said in a statement. “In order to maintain the integrity of the program, it is critically important that MassHealth providers keep accurate records and bill only for services that are medically necessary.”

The news comes following an oversight ramp up and several other Medicaid settlements in the state. In May, Amigos Homecare LLC and Avenue Homecare Services LLC agreed to pay a total of $10 million following similar physician-related Medicaid fraud accusations.

Additionally, Massachusetts home health agency owner Elena Kurbatzky was found guilty of Medicaid fraud last week. She was sentenced to two to three years in prison and will be required to pay MassHealth $1.8 million. Another Massachusetts agency owner, Hellen Kiago, was also found guilty of $2.5 million Medicaid fraud earlier this year.

Patient recruiter found guilty in kickback scheme

A federal jury has found Dominic Trumbo, a home health patient recruiter, guilty of involvement in a $1.3 million Medicare kickback scheme, according to a release from the Department of Justice (DOJ).

The FBI and the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) investigated the case, digging up evidence from 2009 to 2017, when Trumbo owned Trumbo Consulting Agency.

The evidence convinced the jury that Trumbo solicited kickbacks from home health agencies in exchange for patient referrals. Trumbo was convicted of one count of conspiracy to pay and receive health care kickbacks and three counts of receipt of health care kickbacks.

Trumbo is set to be sentenced in December.

He is one of more than 4,000 defendants charged by the Medicare Fraud Strike Force since 2007, according to the DOJ release. In total, those defendants have been found guilty of inappropriately billing the Medicare program more than $14 billion.

Editor’s note (08/21/2019): This story was corrected to fix inaccuracies regarding the nature of Guardian Healthcare’s financial settlement with MassHealth. Guardian Healthcare was not involved in a legal suit involving fraud. For more information, the Massachusetts AG statement is available here.