Mental health provider settles Medicaid fraud charges

BY Emily Micucci

Attorney General Maura Healey filed a lawsuit against a Brockton mental health services provider in January, alleging the agency did not employ qualified social workers in 17 Massachusetts clinics.

Behavioral health services provider South Bay Mental Health Center Inc., which has locations in Worcester and Leominster, has agreed to pay $4 million in a Medicaid fraud settlement with Attorney General Maura Healey’s office, according to a Feb. 8 statement from Healey.
Healey’s office alleged that the Brockton-based agency fraudulently billed the MassHealth program for mental health services provided by unlicensed, unqualified and unsupervised staff at 17 of its clinics across Massachusetts, according to the statement.
Healey launched an investigation after a former South Bay employee filed a whistleblower lawsuit in August 2015. The office uncovered a widespread pattern of employing unqualified staff at its mental health facilities in violation of MassHealth regulations.
Healey alleged all clinics named in the lawsuit featured significant gaps in licensing and supervision of therapists. Many of the employees who were performing mental health services did not have the required degrees in social work, and instead had degrees in such areas as expressive therapy, art therapy, creative arts therapy, school counseling, somatic counseling and agency counseling.
According to the AG’s complaint filed in January, by submitting claims to MassHealth for mental health services provided by unlicensed and unsupervised personnel, the company submitted fraudulent claims in violation of the Massachusetts False Claims Act.
The money from the settlement will be redirected back to the MassHealth program, Healey said.
The settlement agreement requires South Bay to implement an internal program to ensure compliance with all licensure, supervision, billing and quality of care requirements for mental health center staff, and to contract with an independent compliance reviewer to conduct yearly on-site audits that will be reported to the AG’s Office.
Whitney Albert, a spokeswoman for South Bay Community Services, as the agency is now called, said in a statement that the organization is now in compliance.
“We are pleased this matter has been resolved and look forward to continuing to provide quality services to those in need,” Albert wrote.