March 20, 2019

Medicaid fraud division recovered $45M in fiscal 2018

Photo | State House News Service
Attorney General Maura Healey

Attorney General Maura Healey's Medicaid Fraud Division recovered more than $45 million for the MassHealth program in fiscal year 2018 and secured the convictions of three people on charges connected to Medicaid fraud schemes.

Healey's office said Monday that the $45 million recovered by its investigators represented roughly $11 recovered for every $1 appropriated in the fiscal 2018 state budget for its work. The division brought 18 cases, involving pharmacies, home health organizations, and doctors, to civil settlements and criminally charged 11 people with defrauding MassHealth.

"Our Medicaid Fraud Division works every day to protect the integrity of MassHealth and ensure that its funds are used appropriately to support our most vulnerable residents," Healey said. "Each year, we recover millions of dollars for taxpayers and help ensure that residents are getting quality medical care."

Dental practices were a focus of investigators in fiscal 2018. Among the settlements was the $1.7 million Kool Smiles agreed to pay to resolve allegations that the practice performed medically unnecessary dental work on children and a $1.3 million settlement with Dental Dreams, LLC, which was alleged to have billed MassHealth for unnecessary procedures.

Healey's office also secured $20.3 million from pharmaceutical company Mylan in an October 2017 national settlement to resolve allegations that the company knowingly underpaid rebates owed to MassHealth.

MassHealth is the state-run Medicaid program that serves 1.86 million residents and has grown to consume about 40 percent of state spending.

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