Attorney General Sues Worcester Health Agency for Fraud

 by TWIW StaffNovember 20, 2021

WORCESTER - Massachusetts Attorney General Maura Healey filed a lawsuit this week against a Worcester home health agency.

The lawsuit alleges Prestige Health Care Services, Inc., its owner and CEO Isdory Lyamuya, and its Chief Operating Officer Augustus Kormah, falsely billed the state’s Medicaid program, MassHealth, for services that were not authorized by a physician and/or not medically necessary.

The Prestige Health Care Serivces, Inc. office is located at 340 Main Street in Worcester.

“Home health care services assist low-income individuals with activities of daily living, and our office is committed to rooting out fraud within this industry,” said AG Healey. “We allege this agency repeatedly and knowingly billed MassHealth for unauthorized services and are seeking to hold them accountable to ensure our health care dollars are spent appropriately.”

According to the AG’s complaint, Prestige began providing services to patients who did not require services and continued to service patients after they no longer required skilled nursing services. In some instances, physicians did not authorize the services listed in the POC, some returning the POC with notations such as “services not needed.”

The AG alleges when Prestige did receive a rejection, the agency often shredded the document and tried to re-submit it for authorization again. According to the AG's complaint, employees raised concerns with both Lyamuya and Kormah about billing MassHealth without physician-authorization, but no changes were made to the company’s practices.

One employee was allegedly fired a day after she told Lyamuya and Kormah that she was not comfortable billing MassHealth without enough information.

As a result of an audit finding missing physician authorizations for 70 percent of Prestige’s patients, MassHealth withheld further payment to Prestige as of July 26, 2019 and terminated Prestige as a provider on July 29, 2019.

The AG’s lawsuit alleges violations of the Massachusetts False Claims Act, the Medicaid False Claims statute, and the common law, and seeks treble damages and civil penalties.

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