Worcester home health service faces MassHealth fraud lawsuit from attorney general
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Massachusetts Attorney General Maura Healey
Massachusetts Attorney General Maura Healey filed a lawsuit on Tuesday against Worcester home health agency Prestige Health Care Services, Inc. for allegedly falsely billing MassHealth, according to a Friday press release from Healey’s office.
Located on Main Street, Prestige is owned by CEO Isdory Lyamuya and COO Augustus Kormah, whom the attorney general's office is alleging billed MassHealth while knowing patients lacked coverage authorization.
MassHealth, which is the state's Medicaid program, pays for three types of home health care services, including nursing, home health aides, and therapy, according to the press release. To receive MassHealth coverage, the patient’s physician must review and sign a plan of care to certify such services are medically necessary.
Per the attorney general's lawsuit, Prestige was providing services not marked as medically necessary by plan of care documents. An audit found 70% of Prestige’s patients were missing physician authorizations.
In July 2019, MassHealth withheld further payment and terminated Prestige as a provider.
The lawsuit alleges violations of the Massachusetts False Claims Act, the Medicaid False Claims statute, and the common law.
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