Contact our Georgia national whistleblower lawyers today. Call us at 770-643-1606

Exposed: A Real Example of Insurance Fraud in Massachusetts

False Claims Act | SEC Whistleblower Claim

With the costs of health insurance increasingly on the rise despite federal regulations designed to provide affordable healthcare to everyone, companies like Life Focus Center are spending precious taxpayer dollars without the taxpayer’s knowledge. Falsely billing an insurance company, including state-funded Medicaid programs, is a crime – and it carries significant repercussions.

What Is Life Focus Center?
Life Focus Center was a Charlestown non-profit provider of day rehabilitation services to individuals with developmental disabilities, and its goal involved helping these individuals reach their optimal levels of capabilities on the physical, social, cognitive, and even occupational levels. A licensed registered nurse, an occupational therapist, a physical therapist, and a speech and language therapist provided care. According to Life Focus Center, they billed their sessions in 15-minute increments.

Why Was the Billing Fraudulent?
The state of Massachusetts’ Medicaid program, known as MassHealth, forbids day habilitation providers from billing for cancelled or missed sessions, and it also requires healthcare service providers to report the actual amount of time each person in the healthcare team actually spent with the patient. As it turns out, Life Focus Center fraudulently billed more hours of service than provided between 2008 and 2011, a clear violation of the Massachusetts False Claims Act. During this time, the rehabilitation center was involved in a scheme in which it wrongly billed MassHealth for services that it never rendered to a member who either did not attend or attended only very rarely.

The Final Verdict
The investigation of Life Focus Center began with a referral to the Massachusetts Attorney General following a review of the center’s records. Assistant Attorney General Angela Neal and Gregory Matthews from the Attorney General’s Medicaid Fraud Division investigated along with the help of MassHealth and the state auditor. The center closed its doors in 2012, but Bay Cove Human Services subsequently took over and resumed operation. Life Focus Center is no longer a MassHealth provider, and in a settlement between the company and the state, they paid more than $94,000.

Whether the fraud was intentional or the result of poor bookkeeping, it cost the state nearly $100,000 that could have been put to use elsewhere. Fortunately, a review of the billing and a subsequent investigation put a stop to the fraudulent claims, saving the state of Massachusetts and its resident taxpayers tens of thousands of dollars.

If you know of Insurance Fraud in Georgia, contact Bothwell Law Group today for a free consultation.