Pathways of Massachusetts pays $4.6 million for false claims

Boston (WWLP) – Pathways of Massachusetts (Pathways) and its former parent company, Molina Healthcare, Inc. (Molina), paying $4.6 million for false claims and other allegations from the whistleblower.

According to Attorney General Maura Healey’s office, Pathway fraudulently claimed to have submitted to the state’s Medicaid program, MassHealth, for behavioral health care services. They also provided services to patients by unlicensed and unsuitably supervised staff.

The AG office discovered through an investigation that Pathways “failed to meet regulatory requirements for frequency and adequacy of supervision, the qualifications of their supervisors, and that Pathways bills psychotherapy services provided by unlicensed individuals who have not been supervised by appropriately licensed professionals.”

“This company has routinely allowed unlicensed and unsupervised mental health professionals to provide patient care, all while paying MassHealth bills for it,” Attorney General Healy said. “MassHealth patients are entitled to receive treatment from eligible individuals, and my office will continue to hold providers responsible for violating these essential requirements of MassHealth.” AG Healey announced the allegations on Tuesday.

said Philip M. Quinn, Special Agent in Charge, US Department of Health and Human Services, Office of Inspector General – Boston Area. “Departing from legal requirements in order to maximize profits and potentially jeopardize patient safety and well-being is completely unacceptable. We are proud citizens who speak out to help protect our federal health care programs and hold accountable those who seek illegal taxpayer money” .

The whistleblower were former Pathways employees between 2014 and 2018 saying Pathways violated the False Claims Act. To be considered in contravention of the False Claims Act, its clinics did not have the appropriate staff to be considered qualified mental health care centers. a koi tam lawsuit in the US District Court of Massachusetts, former United States. Collins and others. v. Molina Healthcare, Inc. and others seem.

MassHealth has referred an investigation into Pathways. This was started by AG’s Medicaid fraud division. The AG and the US Attorney’s Office have decided to settle the False Claims Act allegations.

Pathways has halted all operations in Massachusetts. Molina settled the state and federal False Claims Act in an investigation of Medicaid fraud and whistleblower allegations for $4.6 million. Since the settlement, AG Healey’s Medicaid Fraud Division has promised high-quality behavioral health services to MassHealth members.

The AG office reached a settlement in October 2021 for the former executives of the South Bay Mental Health, Inc. They paid $25 million to cause false claims to be entered into MassHealth for the services of unqualified physicians who did not have the necessary oversight. Universal Health Services (UHS) has agreed to pay $10 million and establish an independent, multi-year compliance monitoring program.

In July 2020, the Office of the Prosecutor decided to resolve the Escobar case that was handled by Attorney General Ian Marinov, Assistant Attorney General Matthew Jones, investigators Heather Dwyer and William Welch, and all of AG’s Medicaid Fraud Division. The US Attorney’s Office for the Massachusetts District, the Office of the Inspector General for the US Department of Health and Human Services, and MassHealth provided significant 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. The Commonwealth of Massachusetts funds the remaining 25 percent.