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Nine home health agencies overbilled the state by nearly $23m

Several agencies that provide home health services to patients on Medicaid have overcharged the state by nearly $23 million, Baker administration officials said Friday.

The improper billing by nine agencies was uncovered during a recent audit. The audit came after administration officials earlier this year promised to crack down on fraud and waste amid soaring spending on home health services.

The bills were charged to MassHealth, the state’s Medicaid program, which insures 1.8 million people with low or no income. MassHealth accounts for the biggest share of state spending, at more than $15 billion a year.

Officials said nine home health agencies overbilled the state by about $22.5 million, and nine adult foster care agencies overbilled by $500,000. They said the audit also detected “health and safety violations and evidence of non-compliance with state regulations.” MassHealth decided to audit the agencies after identifying “aberrant growth” in spending in those areas.

Officials did not name the agencies but said they are required to reimburse the state and take other steps to correct problems.


MassHealth spent more than $755 million on home health services in the fiscal year that ended June 30, which was an 82 percent increase from just two years earlier. Officials said much of the new spending was driven by 62 companies that began doing business with the state in 2013. That spurred the administration to put a moratorium on new home health agencies earlier this year.

Officials also put new restrictions on which patients could receive home health care, requiring agencies to seek authorization from MassHealth before administering services.

The Home Care Alliance of Massachusetts, a trade association, said it is concerned that those new requirements are burdensome on home health companies. But the group is generally supportive of the administration’s efforts to root out fraud and waste.


“We want the bad apples plucked out, and we want the providers that are providing good care to keep on doing so,” said James Fuccione, director of legislative and public affairs at the trade group.

Home health includes nursing care, physical therapy, and other services. About 30,000 MassHealth members rely on such care every year.

“The spending growth in the home health program and concerns identified by our clinical and program staff . . . prompted us to take a closer look at quality control, claims activity, strengthen oversight, and improve our systems,” Dan Tsai, the head of MassHealth, said in a statement.

MassHealth officials said their audit included home visits and a review of medical records. They found that companies did not properly document services and did not have appropriate sign-offs from physicians, among other problems.

Attorney General Maura Healey’s office also has been investigating suspected fraud in the home health industry, including at companies referred to the office by MassHealth. The investigations are continuing.

Priyanka Dayal McCluskey can be reached at priyanka.mccluskey Follow her on Twitter @priyanka_dayal.