BOSTON (WWLP) – Pathways of Massachusetts (Pathways) and its former corporate parent company, Molina Healthcare, Inc. (Molina), will pay $4.6 million for false claim allegations and other allegations made by whistleblowers.
According to the Office of Attorney General Maura Healey, Pathway fraudulently claimed to be submitted to the state’s Medicaid Program, MassHealth, for behavioral health care services. They also provided services to patients by unlicensed and improperly supervised staff members.
The AG’s Office discovered through an investigation that Pathways “failed to meet the regulatory requirements for frequency and adequacy of supervision, the qualifications of its supervisors, and that Pathways billed for psychotherapy services rendered by unlicensed individuals who were not supervised by appropriately licensed professionals.”
“This company routinely allowed unlicensed and unsupervised mental health professionals to provide care to patients, all while billing MassHealth for it,” said Attorney General Healey. “MassHealth patients deserve to receive treatment from qualified individuals, and my office will continue to hold providers accountable for violating these fundamental MassHealth requirements.” AG Healey announced the allegations on Tuesday.
“Providers of mental health services have an obligation to ensure that patients receive treatment that is necessary, appropriate and is administered with proper clinical supervision,” said Phillip M. Coyne, Special Agent in Charge, U.S. Department of Health & Human Services, Office of Inspector General – Boston Region. “To deviate from legal requirements in order to maximize profits and potentially jeopardize patient safety and well-being is completely unacceptable. We are proud of the citizens who speak out to help protect our federal healthcare programs and hold accountable those who seek to wrongfully obtain vital taxpayer dollars.”
The whistleblowers were former Pathways employees between 2014 and 2018 saying that Pathways violated the False Claims Act. To be considered as violating the False Claims Act, its clinics did not have appropriate staffing to be considered as eligible mental health care centers. A qui tam action in the U.S. District Court of Massachusetts, U.S. ex rel. Collins, et al. v. Molina Healthcare, Inc., et al was initiated.
MassHealth referred an investigation into Pathways. This was initiated by the AG’s Medicaid Fraud Division. It has been decided by the AG’s Office and the U.S. Attorney’s Office to resolve the False Claims Act allegations.
Pathways stopped all operations in Massachusetts. Molina settled the federal and state False Claims Act in the investigation of the Medicaid Fraud Division and the whistleblower allegations for $4.6 million. Since the settlement, AG Healey’s Medicaid Fraud Division has promised quality behavioral health services for MassHealth members.
The AG’s office reached a settlement in October 2021 of previous executives of South Bay Mental Health Center, Inc. They paid $25 million for causing false claims to be entered to MassHealth for services of clinicians what were unqualified and did not have necessary supervision. Universal Health Services (UHS) agreed to pay $10 million and place a multi-year independent compliance monitoring program.
In July 2020, the AG’s Office decided on the resolution of the Escobar case which was handled by Managing Attorney Ian Marinoff, Assistant Attorney General Matthew Jones, and Investigators Heather Dwyer and William Welsh, and all of the AG’s Medicaid Fraud Division. The U.S. Attorney’s Office for the District of Massachusetts, Office of Inspector General for the United States Department of Health and Human Services, and MassHealth provided substantial assistance to this investigation and the resulting settlement.
The AG’s Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award. The remaining 25 percent is funded by the Commonwealth of Massachusetts.