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AG Healey Settles with Mental Health Provider Over Alleged False Claims

  • Massachusetts AG Maura Healey and the DOJ reached a settlement with outpatient mental health company Pathways of Massachusetts, LLC (“Pathways”) and its former parent company Molina Healthcare, Inc. (“Molina”) to resolve allegations that Pathways submitted fraudulent claims to Massachusetts’ Medicaid program in violation of the federal and Massachusetts False Claims Acts.  The settlement further resolved allegations regarding the same conduct set forth in a qui tam action brought by four realtors.
  • According to the settlement agreement, the AG’s office found that Pathways submitted claims for payment to Massachusetts’ Medicaid program, MassHealth, during a period of time when Pathways was in violation of staff qualification and staff supervision regulatory requirements. Because of this, Pathways facilities were in violation of mental health canter licensure requirements and the center did not qualify as an eligible mental health center under MassHealth and Massachusetts Department of Public Health regulations, and thus claims submitted during this time contained implied false certifications that resulted in MassHealth overpaying.
  • Under the terms of the settlement, Molina and Pathways will pay $4,625,000 to the United States and the Commonwealth of Massachusetts. The four whistleblowers will receive a payment of $810,000 and are free to pursue additional claims of reasonable expenses, attorneys’ fees and costs, as well as employment retaliation claims. Molina and Pathways also agree not to submit unallowable costs in the future.