In the latest update from the Attorney General's Office, a Worcester-based home health company and its administrator have entered guilty pleas for swindling the state’s Medicaid program, MassHealth, out of more than $1.6 million. According to a news release provided by the Massachusetts Attorney General's Office, Union Home Health Care Services, along with Bernice Codjia, 41, of Worcester, copped to the charges in Worcester Superior Court.
The court has sentenced Codjia to one year in the House of Correction, suspended for three years, with strict conditions that prohibit her from interacting with MassHealth members or having any involvement in billing for the next three years. Union Home Health Care Services is expected to pay restitution of nearly $300,000 despite the company being defunct and thus unable to foot the entire $1.6 million bill. The AG's Office has spotlighted the case as part of its ongoing efforts to clamp down on fraud within the state's Medicaid system. Trials for other involved parties are reportedly on the calendar.
The Massachusetts GAFC program is designed to help the elderly and people with disabilities live independently by providing assistance with everyday activities. According to the AG's report, this system was manipulated by Union through falsified nursing assessments, which allowed them to bill for services that were neither authorized nor delivered. MassHealth's GAFC program requires a GAFC provider to receive proper authorization from a registered nurse before providing and billing for services.
Other cases related to Medicaid fraud have surfaced recently, indicating wider issues of accountability and oversight within the system. Just this June, the AGO announced a guilty plea from a personal care attendant involved in a scheme similar to Union's, while a MassHealth member and her personal care attendants were handed suspended sentences for their fraudulent activities. The Massachusetts Medicaid Fraud Division, which spearheaded this investigation with help from various state agencies, is funded primarily by a federal grant, with the Commonwealth covering the remaining 25 percent of their budget.
