Attorney General Andrea Joy Campbell announced a $6 million settlement reached with two Weymouth-based ambulance companies, Brewster Ambulance Service, Inc. and EasCare, LLC, as well as their current owners, Mark Brewster and George Brewster, Jr., in a case concerning MassHealth false claims. According to a statement obtained by Mass.gov, the settlement resolves allegations of the companies submitting claims for pricier services than provided, violating medical necessity requirements, and failing to disclose relevant information when applying to serve as MassHealth providers.
The agreement stipulates that the implicated parties will pay the Commonwealth $6 million and will also undertake a three-year independent compliance monitoring program. This program would include the incorporation of updated policies, training mandates, and regular site and records audits, with findings reported back to the Attorney General’s Office (AGO). "When companies violate our laws and defraud the MassHealth program, crucial taxpayer resources are misdirected from paying for health care for those who need it most," AG Campbell stated, highlighting the impact of abuses against public healthcare funds.
Brewster and EasCare, collectively the largest medical transportation provider in the Commonwealth, were investigated over allegations of "upcoding" their claims to MassHealth. This entails billing for more expensive levels of service than were actually provided or necessary, including charges for emergency services when only non-emergency assistance was warranted. The investigation also found that medical necessity documentation was inadequately maintained, breaching MassHealth requirements, and that medical authorization signatures were solicited from providers without the necessary completed documentation.
In addition to the legal implications, the AGO's Medicaid Fraud Division, a Medicaid Fraud Control Unit annually certified by the U.S. Department of Health and Human Services, has a mission to investigate and prosecute healthcare providers defrauding the state's Medicaid program. This division also addresses complaints of abuse, neglect and financial exploitation in healthcare settings. Inquiries concerning Medicaid fraud or related misconduct can be filed via the AGO's website. It's worth noting the Massachusetts Medicaid Fraud Division receives a substantial portion of its funding from federal grants, with an allocation of $5,922,320 from the U.S. Department of Health and Human Services for the fiscal year 2025, and an additional 25 percent funded by the Commonwealth of Massachusetts, tallying to $1,974,102 for the same period.
