Worcester healthcare provider pleads guilty to $1.6M MassHealth fraud scheme
Image | Courtesy of Alison Kuznitz, State House News Service
Massachusetts Attorney General Andrea Joy Campbell speaks to reporters.
For now, the administrator of a Worcester-based group adult foster care company has avoided a one year jail sentence after pleading guilty to charges related to a $1.6-million MassHealth defrauding scheme.
The Massachusetts Attorney General’s Office alleges that Bernice Codjia and Union Home Health Care Services carried out the scheme through MassHealth’s group adult foster care program, which provides daily living assistance to elderly or disabled members, including support with eating, bathing, housekeeping, and laundry, according to an Aug. 14 press release from the AGO.
“I don’t feel good about it,” Codjia said to WBJ over the phone in regards to the charges she’s pled guilty to. She did not answer any additional questions.
A member’s eligibility for GAFC services must be assessed and attested to by a registered nurse, a requirement the AGO alleges Codjia usurped by using fraudulent nursing assessments and forms to enroll patients into MassHealth, subsequently billing the provider for unauthorized GAFC services, according to the release.
Codjia was handed a one-year jail sentence, suspended for three years, given she does not provide services to MassHealth members or bill or supervise the billing of the members.
Similarly, Worcester County Superior Court ordered Union Home Health Care Services to cease offering or providing services or billing for MassHealth members and ordered the company to pay $1.6 million in restitutions. In the end, the provider will only pay approximately $300,000 due to no longer being in business and therefore being unable to pay the full amount.
Codjia’s sentencing comes after she and the company were originally indicted by a grand jury for larceny over $1,200 and Medicaid false claims in November of 2023.
The court has scheduled her co-defendants’ trials.
The AGO’s most recent sentencing follows a string of alleged Central Massachusetts MassHealth fraud schemes, including an alleged $7.8 million submitted in false claims by a Worcester lab, an alleged $1-million scheme carried out by a Millville-based transportation company with services in Worcester County, and an alleged $3-million scheme conducted by a Worcester-based non-emergency medical transportation company.
Mica Kanner-Mascolo is a staff writer at Worcester Business Journal, who primarily covers the healthcare and diversity, equity, and inclusion industries.
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