In a settlement that resolves allegations of fraudulent claims made against MassHealth, the Taunton-based company Northeast Health Services and two former owners agreed to pay $940,000, Attorney General Andrea Joy Campbell announced Monday.
Under its former owners, Northeast allegedly allowed fraudulent claims to be submitted to MassHealth by failing to ensure that some clinicians received proper supervision from a licensed clinician, Campbell's office said in statement.
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“As we urgently address the mental and behavioral health crisis facing our state, our office will continue to enforce the highest possible standards of care among mental health providers to ensure that vulnerable residents receive these critical health care services from trained professionals “, he told the STATEMENT.
The settlement follows a broader effort since Gov. Maura Healey was attorney general “to ensure high-quality mental and behavioral health services for MassHealth members,” the statement said.
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This plan began in October 2021 when a private equity firm and former executives of South Bay Mental Health Center, Inc., agreed to pay $25 million for allegedly causing fraudulent claims submitted to MassHealth, the largest settlement of its kind, according to Campbell's office.
Efforts continued in June 2022 with a $4.6 million settlement with Pathways of Massachusetts, Molina Healthcare, Inc., and in July 2022 with a guilty plea by Nicole Kasimatis, the owner and operator of Fortitude Counseling and Recovery Center in Quincy, which billed MassHealth “and private health insurers for substance use disorder and/or mental health services it did not provide,” Campbell's office said.
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Qualified clinicians and counselors offer mental health services paid for by MassHealth, the statement said. Those clinicians and consultants are “subject to certain licensing and oversight requirements” and must follow “the oversight requirements set forth in applicable regulations,” Campbell's office added.
MassHealth assisted Division Deputy Director Kevin Lownds, Assistant Attorney General Matthew Jones, Senior Healthcare Fraud Investigator William Welsh and Investigator Julia Galvao of the AG's Medicaid Fraud Division with their settlement.
