AG Healey suing mental health center for false billing and unlicensed patient care

Hampden County
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SPRINGFIELD, Mass. (WWLP) – The State Attorney General announced on Tuesday that she has sued a mental health center for fraudulent billing and unauthorized practices.In a news release sent to 22News from State Attorney General Maura Healey’s office, South Bay Mental Health Center falsely billed MassHealth for mental health services provided to patients by unlicensed, unqualified and unsupervised staff members at clinics across the state.

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South Bay Mental Health Center provides services in Attleboro, Brockton, Cape Cod, Chelsea, Dorchester, Fall River, Lawrence, Leominster, Lowell, Lynn, Malden, Pittsfield, Plymouth, Salem, Springfield, Weymouth, and Worcester.“This company provided substandard care to many vulnerable patients and fraudulently billed the state for its inadequate services,” AG Healey stated in the news release. “MassHealth members deserve competent treatment from qualified individuals, and our office will continue to take action in order to remove these significant barriers to accessing critical mental health care in our state.”

The AG’s Office says it’s suing the mental health care for treble damages, civil penalties, and prejudgement interest.AG Healey’s investigation came after word came out that a lawsuit was filed in the state’s U.S. District Court by a former employee of the mental health center in 2015.

According to the news release, the AG’s investigation revealed that the mental healthcare facility had a pattern of hiring unlicensed, unqualified and unsupervised staff, which was in violation of MassHealth regulations. SBMHC submitted false claims to MassHealth, violating the state’s False Claims Act.

The attorney general’s office said that all 17 healthcare facilities listed in the claim had gaps, stating that, “many of the employees at SBMHC clinics who were performing mental health services did not have degrees in social work (and therefore were not even license-eligible) and instead had degrees in such areas as expressive therapy, art therapy, creative arts therapy, school counseling, somatic counseling, and agency counseling.”

AG Maura’s office went on to explain that the Attleboro Clinic had 125 employees, with only two licensed supervisors who were unable to provide necessary supervision to all of the other uncertified employees.

“From August 2009 to the present, MassHealth and its contracted managed care entities paid SBMHC more than $123 million for outpatient services including mental health counseling, such as psychiatric diagnostic evaluations and psychotherapy,” the news release from the AG’s office states. “The AG’s Office estimates that a portion of that $123 million was based on fraudulent claims for services rendered by unlicensed, unqualified, and unsupervised staff to more than 30,000 MassHealth members.”

Along with the AG’s office, the case is also being investigated by the Office of the Inspector General.

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