A Massachusetts-based home health company and its owners will pay millions of dollars to resolve allegations that they falsely billed the state’s Medicaid program, MassHealth.
The home health company is Altranais Home Care LLC, located in Lowell. Massachusetts Attorney General Maura Healey announced Friday that the company and owners Constant Ogutt and Shakira Lubega will pay a total of $3.1 million to resolve allegations associated with the medical necessity of services dating back to 2014.
Specifically, allegations claimed that Altranais Home Care submitted false claims to MassHealth and MassHealth’s managed care entities for home health services not appropriately authorized by a physician. The provider did so “knowingly” or “in reckless disregard of billing requirements,” according to the attorney general.
“Home health companies have an obligation to provide only those services that are medically necessary,” Healey said in a statement. “This company allegedly defrauded MassHealth and improperly used scarce resources for services that were not deemed necessary by a physician.”
The settlement is part of a broader home health enforcement effort in Massachusetts to combat fraud, waste and abuse.
In April 2019, Avenue and Amigos Home Care paid a combined $10 million to resolve allegations of similar false billing. In August 2019, Guardian Healthcare paid $1.95 million to resolve similar allegations, too.
Juries additionally convicted owners of home health care agencies in connection with other schemes to defraud MassHealth in May 2019 and August 2018.
As part of its business mix, Altranais Home Care provides skilled nursing, therapy and social services. The company’s founders — both nurses — opened their first location in Tewksbury, Massachusetts, before expanding throughout the east, central and western portions of the state.
Financial settlements to resolve allegations associated with the medical necessity of services are not uncommon in the industry. Such settlements are also not an admission of guilt by the provider.
Apart from its financial settlement, Altranais Home Care will be mandated to operate under a multi-year independent compliance program, according to the Massachusetts attorney general.
The program will be implemented by “an independent compliance monitor.” It will require the company to establish updated policies and procedures ensuring compliance with federal and state laws. It will also require the provider to conduct annual training for all employees and perform annual audits, the results of which will be reported to the attorney general’s office.
“Today’s outcome is the result of MassHealth’s strong program integrity efforts to prevent fraudulent billing, and demonstrates the ongoing relationship between MassHealth and the Medicaid Fraud Division,” Dan Tsai, assistant secretary for MassHealth and the Massachusetts Medicaid director, said in a statement.
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