The Massachusetts Attorney General’s Office has made public a significant indictment involving several MassHealth providers, accused of engaging in fraud and kickback schemes. Revealed by the Suffolk County Statewide Grand Jury, the indictment implicates Central Lab Partners, LLC, Patient Care Solutions, LLC, Optimum Labs, Inc., and Dr. Maria Batilo, among others, in fraudulent activities totaling over $7.8 million in false claims to MassHealth. Details from the indictment suggest a range of charged offenses including Medicaid False Claims, Larceny, and Medicaid Kickbacks.
Prosecutors allege there was a network of schemes at play. According to the Attorney General’s Office, these providers submitted claims for urine drug tests and home health services that were either not provided at all, deemed medically unnecessary, or not properly authorized by a prescribing physician. Specifically, the lab and the home health agency identified sober homes desiring frequent drug tests for residents, then enrolled those individuals in services to satisfy sober home protocols, not medical necessity as per MassHealth standards.
Furthermore, the AG’s Office reports that in order to disguise these services as legitimate, sanctioned by health care providers, and therefore billable to MassHealth, payments were allegedly made to Dr. Batilo. In return, Batilo is accused of authorizing services from both PCS and CLP without actual involvement in the patients’ care. It was also suggested that PCS had submitted claims for services to MassHealth including instances where patients were hospitalized or even deceased…