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BOSTON — Maestro-Connections Health Systems, a home health care company with a branch in Lynn, and company CEO George Kiongera are required to pay $10 million to resolve allegations of fraud in a settlement reached last week with Attorney General Maura Healey’s office.
It was alleged that from January 2014 through August 2019 Maestro knowingly submitted false claims to MassHealth for home health services that had not been authorized by a physician.
The AG’s office reported that the allegations are not specific to Lynn but that they do encompass patients treated by Maestro’s Lynn branch at 225 Boston Street.
“MassHealth identified allegations of fraudulent billing by Maestro and referred the company to the Attorney General’s Medicaid Fraud Division,” said Assistant Secretary for MassHealth and Medicaid Director Dan Tsai. “Today’s outcome demonstrates the ongoing work between MassHealth and the Medicaid Fraud Division and MassHealth’s program integrity efforts to prevent inappropriate payments.”
To bill MassHealth for home health services, a provider like Maestro must ensure that the member’s physician has signed off on a plan of care certifying that home health services are medically necessary and maintain records of these services for at least six years.
The AG’s office alleges that Maestro billed for services when it did not have these valid plans from physicians.
The allegations came to light via complaints that the AG’s Medicaid Fraud Division received through its hotline and through a referral from MassHealth. This case is part of a broader push from AG Healey to combat fraud in the home-health industry.
“Companies like Maestro that defraud MassHealth take vital resources away from the program and the people who need them most,” said Healey. “Since 2016, my office has recovered $40 million for MassHealth by combating fraud, waste, and abuse in the home health industry. Our work continues to ensure health care dollars are spent appropriately.”
This isn’t the first time that the AG’s office has targeted Maestro.
In November 2017, Maestro and Kiongera settled with the AG’s Fair Labor Division, agreeing to pay more than $1 million in restitution and penalties for failure to pay overtime to more than 600 home-health aides and for failing to keep accurate payroll records.
The investigation found that Maestro did not pay its home health aides time-and-a-half when they worked over 40 hours in a week as is required by state law. Employers are also required by state law to keep true and accurate records of the hours their employees work, which according to the AG’s office Maestro did not do.
Maestro employees received an average of $1,450 from the suit.
In addition to the $10 million financial payment, the 2020 fraud settlement also includes a requirement that Maestro not resume providing services to MassHealth members until it has hired an independent compliance monitor to oversee a three-year compliance program.
That program will include updated policies and procedures, new training for staff, and yearly audits conducted by the monitor.
Maestro representatives could not be reached regarding the settlement.
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