By Susannah Sudborough
masslive.com
WEYMOUTH, Mass. — Two Weymouth-based ambulance companies have agreed to pay back $6 million to the state for overcharging MassHealth through false claims, the Massachusetts Attorney General’s Office announced Monday.
The attorney general’s office said it began investigating allegations Brewster Ambulance Service and EasCare after receiving a whistleblower lawsuit filed in Massachusetts, the attorney general’s office said in a press release. The two companies provide ambulance and wheelchair transportation services to MassHealth patients across Greater Boston the South Shore and are, collectively, the largest medical transportation provider in the state.
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Brewster Ambulance CEO Mark Brewster said in a statement to MassLive that the company was “pleased” to have settled the lawsuit.
“To be clear, the trips at issue were completed and this settlement reflects concerns about paperwork,” the statement reads. “We stand ready to work with state leaders and regulators to help clarify and strengthen documentation requirements so that this type of litigation doesn’t continue to impact our industry and our health care system.”
The attorney general’s office’s investigation uncovered that Brewster Ambulance and EasCare fraudulently “upcoded” MassHealth claims by billing for more expensive levels of services than they actually provided or were required, the attorney general’s office said. In some cases, they billed for emergency services when only nonemergency services were provided or required.
Additionally, the companies fraudulently billed MassHealth for medically unnecessary services and nonemergency services without maintaining the required, relevant medical necessity documentation, the attorney general’s office said. Similarly, they are alleged to have requested medical authorization signatures from providers without presenting required, relevant and completed medical necessity documentation.
Finally, the attorney general’s office alleged that, when submitting their MassHealth provider applications, Brewster Ambulance and EasCare failed to disclose to relevant information concerning owners, managers and employees of the companies.
The attorney general’s office asserts that the companies’ actions constituted violations of various state laws, including the Massachusetts False Claims Act.
As part of the settlement, Brewster Ambulance Service, EasCare and their owners — Mark Brewster and George Brewster Jr . — will implement a three-year independent compliance monitoring program at their own expense. The program will include updated policies and procedures, training requirements and annual site and records audits — the results of which will be reported to the attorney general’s office.
“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,” Massachusetts Attorney General Andrea Campbell said in the release.
“I am proud to announce this settlement, which will provide meaningful restitution to the Commonwealth and ensure compliance with laws that enable the MassHealth program to serve the millions of residents who depend on it for their healthcare needs.”
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