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Massachusetts alleges Medicaid fraud in federal lawsuit

January 9, 2018

BOSTON (AP) — A mental health provider that has served tens of thousands of low-income Massachusetts residents fraudulently billed the state’s Medicaid program by allowing unlicensed, unqualified and unsupervised employees to see patients, Attorney General Maura Healey said Tuesday.

South Bay Mental Health Center Inc. provided those services for MassHealth patients in violation of regulatory requirements, Healey said in announcing a federal lawsuit against the company.

Of the $123 million the state has paid South Bay since 2009, a “significant portion” was based on fraudulent claims, Healey said.

The suit seeks unspecified triple damages, civil penalties and interest.

“This company provided substandard care to many vulnerable patients and fraudulently billed the state for its inadequate services,” Healey said.

Brockton-based South Bay, which now goes by the name South Bay Community Services, provided services for about 30,000 people at 17 locations across the state during the timespan in question.

“South Bay Community Services does not agree with the allegations and intends to follow the legal steps necessary to resolve this matter as efficiently as possible,” the company said in a statement. “We remain focused on the well-being of our consumers and employees. Our daily operations have not been affected, and we will continue to provide the best possible behavioral health services to those who need it most in the New England area.”

Healey’s office started investigating after a former South Bay employee filed a federal whistleblower suit in 2015.

Many employees at the company’s clinics who were performing mental health services did not have degrees in social work and instead had degrees in such areas as art therapy and school counseling, the attorney general said.

At the Attleboro clinic, for example, only two of 125 employees were licensed supervisors and they could not have possibly provided the necessary supervision to all of the other unlicensed clinicians, authorities said.

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