BOSTON — Attorney General Maura Healey announced today that a Lowell adult day health provider will pay $386,861 to resolve allegations that it improperly billed the state’s Medicaid program, MassHealth, for COVID-19 emergency-related retainer payments intended to support adult day health (ADH) facilities from April 1, 2020 through to July 31, 2020. In the early days of the COVID-19 pandemic, MassHealth issued additional rate provisions to help ensure that ADH centers did not go out of business.

The AG’s Office alleges that Active Day of Lowell, one of nine “Active Day” locations  that provide specialized care to adults with disabilities in Massachusetts, submitted claims to MassHealth for COVID-19 retainer payments at a much higher frequency than it was allowed under those rate provisions. ADH centers were eligible to receive retainer payments equal to the full amount of the per diem rates per MassHealth member for “each day in which that member would have been scheduled to attend” the ADH center.

After a referral from MassHealth, an investigation by the AG’s Medicaid Fraud Division found that Active Day of Lowell billed for retainer payments for members at a much higher frequency than the member had been scheduled to attend Active Day of Lowell prior to the COVID-19 pandemic, in violation of MassHealth rate provisions. Active Day also billed MassHealth for services to members who were receiving care in inpatient or nursing home settings, not from Active Day of Lowell.

“False billing to MassHealth takes resources away from state programs that provide essential health care to some of our most underserved populations,” said AG Healey. “This provider cheated the system by taking advantage of retainer payments intended to keep facilities in business during the pandemic.”

The settlement announced today follows a June 2022 settlement the AG’s Office reached with a Worcester adult day health provider to resolve allegations that it improperly overbilled MassHealth by reporting that more people were provided care  than actually received services. In 2021, the AG’s Office recovered more than $1 million in settlements with two adult day health centers in Marlborough and Lowell that improperly billed MassHealth for services not provided and overbilled for other services.

This matter was handled by Assistant Attorney General Gregoire Ucuz and Investigator Heather Dwyer of the AG’s Medicaid Fraud Division. MassHealth provided substantial assistance with the investigation.

 

The Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award. The remaining 25 percent is funded by the Commonwealth of Massachusetts.

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