Massachusetts Home Health Company Will Pay $1.95M to Settle Allegations in Medicaid Billing Case

by Andrew Murray | September 25th, 2019

On August 15, 2019, the Massachusetts Attorney General announced the settlement. The Press Release states:

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A Boston-based home health care company will pay $1.95 million to resolve allegations that it filed claims for payment with the state’s Medicaid program (MassHealth) for services that were not certified as medically necessary, Attorney General Maura Healey announced today.

Guardian Healthcare, LLC will pay $1.95 million to resolve allegations it submitted claims to MassHealth for home health services that had not been appropriately authorized by a physician.

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In order for a home health agency to bill MassHealth for home health services, a member’s physician must review and sign a plan of care certifying that home health services are medically necessary. Home health agencies are required to maintain these records for at least six years after the medical services are provided and claims have been made. The AG’s Office alleges that from April 2010 through July 2016, Guardian failed to obtain and/or maintain plans of care authorized by a physician for certain patients.

In addition to the financial settlement, Guardian has also agreed to implement a multi-year, independent compliance program which will involve updating its policies and procedures, training its staff, and conducting annual audits to ensure compliance with federal and state regulations.

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