Molina Healthcare agrees to pay over $4.5 million to resolve alleged misrepresentation law violations | USAO-MA

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 they violated the False Claims Act by submitting claims while violating several regulations related to personnel licensing and supervision.

Molina is a managed health care 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 this period, the government alleges that Molina and Pathways improperly submitted claims for reimbursement to MassHealth and MassHealth-operated care entities while failing to properly authorize and supervise mental health center staff, including social workers and psychological associates, and failing to provide a document in a timely manner. the provision of adequate clinical supervision to clinicians requiring supervision.

The settlement also resolves allegations brought in a lawsuit brought by whistleblowers under the qui tam provisions of the False Claims Act, which allow private parties, known as relators, to bring a action on behalf of the government and to share 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 case 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 Medicaid Fraud Division of the Massachusetts Attorney General’s Office. .

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