BOSTON – Molina Healthcare, Inc. (Molina) and its previously owned subsidiary, Pathways of Massachusetts (Pathways), have agreed to pay $4.625 million to resolve allegations that it violated the False Claims Act by submitting reimbursement claims while violating several regulations related to the licensure and supervision of staff.
Molina is a managed care health services company that provides health care plans to various state and federal health care programs including MassHealth, the joint federal and state Medicaid program. Between November 2015 and March 2018, Molina owned and operated Pathways, a group of mental health centers located in Springfield and Worcester.
During that period, the government contends that Molina and Pathways improperly submitted claims for reimbursement to MassHealth and care entities managed by MassHealth while failing to properly license and supervise mental health center staff, including social workers and psychological associates, and failing to provide and timely document the provision of adequate clinical supervision to clinicians requiring supervision.
The settlement also resolves allegations brought in a lawsuit filed by whistleblowers under the qui tam provisions of the False Claims Act, which allow private parties, known as relators, to bring suit on behalf of the government and to share in any recovery.
United States Attorney Rachael S. Rollins; Massachusetts Attorney General Maura Healey; and Phillip M. Coyne, Special Agent in Charge of HHS-OIG, made the announcement today.
The matter was handled by Assistant U.S. Attorney Steven Sharobem, of Rollins’ Affirmative Civil Enforcement Unit, and Assistant Attorneys General Ian Marinoff and Matthew Jones, of the Massachusetts Attorney General’s Office’s Medicaid Fraud Division.
The defendant/respondent, Molina Healthcare, Inc. (Molina), has agreed to pay $4.625 million to resolve allegations of False Claims Act violations. The exact criminal charges against Molina are violations of the False Claims Act by submitting reimbursement claims while violating several regulations related to the licensure and supervision of staff. This incident occurred in Massachusetts, between November 2015 and March 2018. The outcome of this case is a settlement where Molina will pay $4.625 million.
Defendant/respondent: Molina Healthcare, Inc. (Molina)
Exact criminal charges: Violations of the False Claims Act by submitting reimbursement claims while violating several regulations related to the licensure and supervision of staff.
City and state: Boston, Massachusetts
Exact date: Between November 2015 and March 2018
Sentence or outcome: $4.625 million settlement
Dollar amount: $4.625 million
Related Federal Cases
- Omnicare Inc., False Claims Act Violations, Sacramento CA, 2023 · Massachusetts
- Kenyada Spates, Conspiracy to Make False Claims, Euclid OH, 2023 · Kentucky
- Roger Martin, False Mayday Calls, Massachusetts 2023 · Massachusetts
- HHS Office of Inspector General, Healthcare Fraud Crackdown, Washin… · Washington
- Viviane Cazeau, Bank Fraud Scheme, Massachusetts, 2023 · New Hampshire
Key Facts
- State: Massachusetts
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
ðŸâ€Â’ Get the grimiest stories delivered weekly. Subscribe free →
MORE FEDERAL CRIME NEWS
US NewsUS NewsUS NewsUS News