Marlborough, Lowell adult day health centers fined $1M over billing

Photo | SHNS Massachusetts Attorney General Maura Healey

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Two adult day health centers, both owned by Malay Patel of Lowell, will pay out a cumulative $1,060,957 to settle allegations they improperly billed MassHealth for their services since 2014, Attorney General Maura Healey announced on Thursday.

The facilities are Fun Life Adult Day Care in Marlborough and Monarch Elder Care in Lowell, which were accused of billing MassHealth for services not provided or which exceeded allowable billing practices, violating MassHealth regulations, according to Healey’s office.

The investigation by Healey's office found Fun Life and Monarch billed for more hours than members actually attended adult day health programs, according to Healey's announcement, and they improperly submitted claims in excess of per diem billing requirements.

The companies agreed to a three-year monitoring period, during which they will hire a third party to launch an internal compliance review, which will include implementing updated policies and procedures on billing, new training for billing staff, as well as yearly audits, at the expense of the centers.

“False and improper billing to MassHealth takes away critical funds from a program that provides health care to some of our most underserved populations,” Healey said in a press release. “Companies must follow MassHealth billing regulations to ensure these critical resources are being allocated appropriately.”