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South Bay Mental Health Center to pay $4 million Agency reaches settlement with state on allegations of fraudulent billing

Weymouth News - 2/14/2018

South Bay Mental Health Center, Inc., which operates Weymouth Mental Health Clinic, has agreed to pay $4 million based on allegations that it fraudulently billed the state's MassHealth program for services provided to patients by unlicensed, unqualified, and unsupervised staff members at 17 clinics across the state, according to state Attorney General Maura Healey.

"Thousands of MassHealth patients were left with inadequate care at these mental health facilities, while we allege this company fraudulently billed the state," Healey said in a written statement, Thursday. "This settlement will bring critical funds back to our MassHealth program and ensure that members receive treatment from qualified individuals. Companies that receive payments from taxpayer-funded programs must be held accountable when they abuse this system."

Healey spokeswoman Emaile Gainey previously said the regional health director and health director at Weymouth Mental Health Clinic were not licensed for their positions under state law and during their employment with South Bay Mental Health.

The majority of the staff therapists at the Weymouth facility were also not licensed and the agency was billing MassHealth for services by unlicensed clinicians who were not being supervised properly, according to Gainey.

An investigation into the allegations against South Bay Mental Health Center was launched after a whistleblower lawsuit was filed by a former employee in August 2015.

Healey stated the investigation by her office revealed South Bay Mental Health Center had a widespread pattern of employing unlicensed, unqualified, and unsupervised staff at its 17 mental health facilities in violation of MassHealth regulations.

South Bay Mental Health Center operates mental health facilities in Attleboro, Brockton, Cape Cod, Chelsea, Dorchester, Fall River, Lawrence, Leominster, Lowell, Lynn, Malden, Pittsfield, Plymouth, Salem, Springfield, and Worcester, in addition to Weymouth.

Healey's complaint alleged that South Bay's Mental Health Clinic violated the Massachusetts False Claims Act by submitting claims to Mass Health for services provided by unlicensed and unsupervised personnel.

The lawsuit alleged that all of the 17 clinics named in the complaint featured significant gaps in licensing and supervision of therapists during the relevant time period.

"Many of the employees at South Bay Mental Health Clinics 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," stated a summary provided by Healey's office. "For example, the Attleboro Clinic, which had 125 employees, had only two licensed supervisors who could not have provided the necessary supervision to all of the other unlicensed clinicians."

Under the terms of the settlement, South Bay Mental Health Center will pay a total of $4 million, with $700,000 going to the individual who was involved in the whistleblower case, and the remaining amount will be paid to MassHealth.

The settlement agreement also requires South Bay Mental Health Center to implement an internal program to ensure compliance with all licensure, supervision, billing, and quality of care requirements for mental health center staff, and to contract with an independent compliance reviewer to conduct yearly on-site audits that will be reported to the attorney general's office.

The complaint also named H.I.G. Growth Partners, LLC and H.I.G. Capital, LLC (collectively, HIG), which created Community Intervention Services (CIS) to acquire South Bay Mental Health from Scanlon, as well as co-founder and CEO of Community Intervention Services until November 2016 Kevin P. Sheehan.

Litigation against the remaining four defendants remains ongoing, according to Healey.

The investigation revealed that SBMHC had a widespread pattern of employing unlicensed, unqualified, and unsupervised staff at its mental health facilities in violation of MassHealth regulations, according to Healey.

MassHealth pays for mental health services provided to MassHealth members by qualified clinicians and counselors who are subject to certain licensure and supervision requirements. Mental health centers that employ those rendering mental health services must comply with certain core staffing and supervision requirements set out in applicable regulations.

This case is being handled by Assistant Attorneys General Robyn Dollar, Gregory Matthews, and Kevin Lownds, along with Investigations Supervisors Denise Long and Lisa Bailey and Auditor Kaleigh Ross, all of the AG's Medicaid Fraud Division, with substantial assistance from the Office of the Inspector General and MassHealth.

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