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MassHealth Endures Mass Overbilling, According To Audit

Over the past few months, we’ve taken the opportunity to research countless stories, that can be found online, detailing the inner workings of medical professionals. And by “inner workings”, we’re referring to the fact that fraudulently billing our nation’s health insurance programs has become somewhat of an art form in our country. This isn’t an art form, however, that deserves praise. It happens to be one of America’s biggest fails.

We’ve noticed that physicians, health care clinic owners and other members of the health care industry are routinely finding ways to bilk Medicare and Medicaid out of millions and millions of dollars. This strikes a nerve with the team, here at Allegiant Experts, not only because such fraud is clearly illegal, but because it takes advantage of the sick, injured, poor and unfortunate. Needless to say, the money made available by such programs is meant for very important purposes.

The Medicaid programs in some states are being particularly hit hard by instances of fraud. As reported in the Boston Globe by Priyanka Dayal McCluskey last week, the Massachusetts Medicaid program, known as MassHealth, has been overbilled by several health care service providers to the tune of $23 million. “The state’s Medicaid program was routinely billed for home health care services that were never provided or were not medically necessary,” she writes.

In addition, many providers submitted documents that had missing dates and signatures. Even simple information like a patient’s medical history was often absent from the documents. All discovered by an audit that discovered overbillings from such companies as Nizhoni Health Systems, Avenue Homecare Services, Century Homecare and Maestro-Connections Health Systems, the Medicaid overbillings are being appealed by the accused.

Executives representing each of the companies are in the midst of preparing documents that they believe will clear their organizations of any wrongdoing. It is proposed that “minor paperwork issues” can be blamed for some of the overbillings found by the audit. “We are hopeful that MassHealth will look favorably upon our reply to these preliminary findings,” a spokeswoman for Nizhoni is quoted as saying in a statement.

James Njoroge is the chief executive of Century Homecare. He believes that the audit revealed what he calls “minor” violations like late signatures from doctors ordering services. Njoroge also reports a heavier emphasis on compliance at his company since the audit took place last year. “If the [state] were to conduct an audit for a more recent period, Century is confident that it would not find similar technicalities,” he is quoted as saying.

“All together, nine agencies were accused of overbilling the state by nearly $23 million,” informs McCluskey, “MassHealth officials said they are continuing to audit other home health companies they suspect of violations. They point to a staggering increase in home health spending — 82 percent over just two years — as proof that spending must be studied and controlled. MassHealth, a $15 billion-a-year program that covers 1.8 million residents, spent more than $755 million on home health services in the fiscal year that ended June 30.”

Can anything really be done to prevent such instances of overbilling? At Allegiant Experts, we are committed to doing our part. Our team of clinical experts is dedicated to assisting attorneys with their litigations against those who commit fraud in the medical world. For more information on how we may be able help your case, please don’t hesitate to contact us at 407-217-5831.

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