AG Healey: Home care agency agrees to pay $14M to MassHealth for improper billing

Centrus Premier Home Care Inc. has six locations in Massachusetts

Attorney General Maura Healey [Photo: Colin A. Young/SHNS]

BOSTON (WWLP) – A national home health agency that does business in Springfield and other locations across the state will be paying more than $14 million to settle allegations of improper billing.

According to a news release sent to 22News from State Attorney General Maura Healey’s Office, Centrus Premier Home Care Inc. also known as Maxim Healthcare Services Inc. improperly submitted and received overpayments for services from the state’s Medicaid program MassHealth.

In addition to Springfield, the home care agency serves five other locations in Massachusetts including Needham, Plymouth, Taunton, Wilmington and Worcester.

“This company billed MassHealth for services that were not eligible for reimbursement under state regulations and with the voluntary disclosure of these over payments, will pay more than $14 million in this settlement,” AG Healey stated in the news release. “Home health agencies must be diligent in their billing practices to preserve the integrity of this program, which provides critical health care services to low-income individuals across our state.”

The AG’s office said that MassHealth reported this matter to the AG’s Medicaid Fraud Division in January 2017, after a voluntary provider overpayment disclosure by Maxim to MassHealth in October 2016.

The disclosure showed that claims were improperly submitted to and paid by MassHealth for home health aide services provided through Maxim when nursing or skilled therapy services were not necessary.

AG Healey’s office said 80 percent of home health spending growth had been driven by providers new to Massachusetts since 2013 and that during that time period, MassHealth regulations allowed payments from home health aide services only if a patient had “a medically predictable recurring need for nursing services or therapy services” and provided that in order to “receive intermittent or part-time nursing care, the member must have a medically predictable recurring need for skilled nursing services at least once every 60 days.”

The AG’s office said their investigation found that between March 2010 and October, Maxim submitted and received payment for nearly 95,000 claims for services that were not covered by MassHealth regulations.

The settlement requires Maxim to pay $14,264,803 to MassHealth and includes compliance conditions going forward for three years, the AG’s office said.

The home health agency is also required to provide annual written certification to the attorney general’s office of compliance with these conditions and provide training to all employees involved in the MassHealth billing process regarding applicable statuses.

So far, AG Healey’s office has taken criminal action against three other home health agencies and their owners, including Compassionate Homecare, Harmony Home Health Care and Lifestream Healthcare Alliance, for allegedly over billing and falsely billing MassHealth and for home health services that were not authorized or provided, the attorney general’s office said.