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Former Massachusetts Nonprofit To Pay More Than $94,000 for Billing Medicaid for Services Investigators Determined Were Not Provided

Life Focus Center of Charlestown, Inc., a former Massachusetts nonprofit that provided day habilitation services to individuals with developmental disabilities, has agreed to pay more than $94,000 to settle claims that it billed MassHealth, the state’s Medicaid program, for services an investigation revealed were never rendered.
According to the settlement announced on April 28, 2015 by Massachusetts Attorney General Maura Healey, Life Focus Center violated the Massachusetts False Claims Act by billing MassHealth during 2008 to 2011 for services the company said it provided to MassHealth members who either failed to attend the billed sessions or who only attended on rare occasions.
Under MassHealth regulations, providers must report the actual time spent by each member in the program. Cancelled sessions or sessions missed by a member are not billable by day habilitation providers, nor are those portions of a day billable during which the member is not present on the site, unless the provider can show that the member received services from the provider’s staff in a community setting.
The investigation against Life Focus Center was initially referred to the AG’s Office by MassHealth following a review of its billing, and was conducted by the AG’s Medicaid Fraud Division, with assistance from MassHealth and the State Auditor’s Office.
Under Federal law, individuals who report fraud to the government are sometimes entitled to monetary awards. If you are aware of wrongdoing and would like to know more about your rights, please click here.

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