An Essex County man has been convicted of Medicaid fraud after a five-day trial for falsifying claims for autism therapy services. Donald Martel, 69, of Georgetown, was found guilty of submitting claims for applied behavioral analysis (ABA) services that were not provided, according to information released by the Attorney General's Office yesterday. Martel will serve three years on probation and is required to make full restitution. He must also avoid any contact with witnesses and is barred from any work or billing involving MassHealth members.
In the case presented to an Essex County Superior Court jury, Martel was convicted of Medicaid False Claims and Larceny over $1,200. Documents reveal that he was charged in 2022 after an investigation by the AGO’s Medicaid Fraud Division. The investigation found that, between April 8, 2019, and October 22, 2019, Martel billed for services to a patient who was incarcerated or in a mental health facility at the time, claiming at least $33,000 from MassHealth funds that were never used for patient care, as reported by the Massachusetts Attorney General’s Office.
ABA services are a crucial component of autism care, offering therapies necessary for the development and improvement of those on the Autism Spectrum Disorder. These services are covered by MassHealth for children under 21, and are designed to provide professional guidance that helps these individuals gain crucial life skills. The fraudulent claims made by Martel took advantage of this vital healthcare provision.
Attorney General Campbell's office has been actively pursuing ABA provider fraud and a part of this pursuit led to the conviction of Martel. The efforts have continued since December 2022, with the AGO recovering $2.5 million in settlements from two ABA providers who, like Martel, were accused of filing fraudulent claims. These other providers had also submitted claims for services that were either undocumented, performed by unqualified individuals, or not conducted following the supervision requirements.
The team behind Martel's investigation and prosecution included Assistant Attorneys General William Champlin and Joanna Staley, Senior Healthcare Fraud Investigator Heather Dwyer, and Investigator Kevin Todd from the AG's Medicaid Fraud Division. Several organizations, including MassHealth, Carelon, the Essex County Sheriff’s Department, Fuller Hospital, and Worcester Recovery Center and Hospital, provided essential support throughout the process.
Contributing to the fight against healthcare fraud, the AGO’s Medicaid Fraud Division operates as a Medicaid Fraud Control Unit, certified annually by the U.S. Department of Health and Human Services. Their jurisdiction isn't limited to prosecuting healthcare providers who defraud MassHealth but also encompasses investigating and addressing complaints of abuse or neglect in context to long-term care resident and Medicaid patients in various healthcare settings. The public is encouraged to report these instances of fraud or abuse by visiting the AGO's website. The division’s activity is primarily funded by grants from the U.S. Department of Health and Human Services, with a portion provided by the Commonwealth of Massachusetts.
