Medicaid provider accused of fraud
A Framingham-based nonprofit agency promoted themselves as a compassionate organization that sent home health aides to help disabled, indigent adults, except there was one glaring problem, prosecutors allege: They were charging the state’s Medicaid program for some 20 patients who had been dead for some time. And some patients had never been cared for - even while alive - by Adlife Healthcare, but were simply names plucked randomly from municipal census lists collected by staffers. This scheme was among four outlined by Attorney General Martha Coakley yesterday that together allegedly bilked $10 million from MassHealth, the state’s Medicaid health insurance program for the poor. In all, 10 people were indicted as of yesterday in operations that included a Brookline-based drug-addiction clinic, a New Bedford therapy office, and a Jamaica Plain now-defunct nursing homes.Others indicted yesterday included Dr. Punyamurtula Kishore, 61, a Brookline drug-addiction specialist who had been arrested nine days ago on an initial charge, though the full scope of the grand jury case against him was not made clear until yesterday. His arrest was put on an accelerated schedule by prosecutors because they feared he was about to flee the country, perhaps to his native India.
Yesterday, Kishore was charged with building a urine-screening business by bribing at least four operators of sober houses, facilities for recovering substance abusers, to send referrals his way. The intricate kickback scheme involving his company, Preventive Medicine Associates, produced $3.8 million in fraudulent Medicaid billing by using bribery as a means to get business, the state alleges.
Carolyn Wetterberg, 70, of Weymouth, was indicted for allegedly billing MassHealth for more than $600,000 in acute-level services not provided in her now-defunct nursing home, known as Pond View Nursing Facility in Jamaica Plain. The state alleged that she and her staff exaggerated the disabilities of patients in the 43-bed nursing home in order to get the inflated reimbursements.
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These billing practices, as well as three other unrelated Medicaid fraud schemes in the state, siphoned a total of $10 million from MassHealth, the state's Medicaid program providing health insurance for the poor, Attorney General Martha Coakley said
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Your Guide to Public Benefits in Massachusetts
Find, understand, and apply for programs in your state that can help:
Increase your income, Save money on prescription drugs Pay doctors’ bills; Buy groceries; and Cover other basic costs.This fact sheet describes the programs in your state, helps you decide which are right for you, and tells you how to sign up. Income guidelines, eligibility requirements, and telephone numbers are subject to change. For the most up-to-date information in your ZIP code area log on to www.aarp.org/quicklink .
You can also go to the Benefits QuickLINK website ( www.aarp.org/quicklink ) to find out if you qualify for the benefits listed below or to print out applications for programs in your state.
Paying for Health Care and Prescription Drugs MedicareBenefit: Health insurance that helps pay for preventive care, doctor visits, hospital stays and tell the operator where you live. You can also log on to www.socialsecurity.gov and select “Questions about Medicare.” For information about the Medicare prescription drug coverage, call 1-800-MEDICARE ( 1-800-633-4227 ) or log on to www.medicare.gov .
For additional assistance, call Serving the Health Information Needs of Elders (SHINE), also known as the Massachusetts State Health Insurance Assistance Program (SHIP), toll-free at 1-800-841-2900 or log on to www.mass.gov and type in the search term “SHINE.”
Medicare Savings ProgramsBenefit: Pays for some of the costs of Medicare, including the Part B premium, deductibles, and co-payments. How much you get depends on your income and assets.
Who can apply: People who get Medicare and earn around $1,219 per month for one person, or $1,640 per month for a married couple.
How to apply: Call the MassHealth Enrollment Center toll-free at 1-888-665-9993 to request a MassHealth Application or log on to www.mass.
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