Medical transportation company accused of bilking MassHealth out of $19M

A grand jury has indicted the owner and managers of a medical transportation company for allegedly defrauding one of the largest insurers in Massachusetts of $19 million, according to a report published on MassLive.com.

Massachusetts Attorney General Maura Healey said in a statement that Westminster, Mass.-based Rite Way repeatedly billed MassHealth, the state's combined Medicaid and State Children's Health Insurance Program, for transportation services that were never provided. The company allegedly made claims for individuals who were hospitalized in inpatient settings, no longer used the company's services, or were deceased on the claimed dates of service. The purported fraud took place between April 2011 and September 2015.

"We allege that in order to rack up millions of dollars in payments from the state, this company orchestrated a massive false billing scheme for transportation services that they never provided or were not necessary," AG Healey said.

The AG's Office began an investigation in 2013 into Rite Way after MassHealth identified instances of potentially fraudulent billing, according to the report.

"In the fall of 2013 MassHealth identified allegations of fraudulent billing by transportation provider Rite Way and referred the company to the Attorney General's Medicaid Fraud Unit," Secretary of the Executive Office of Health and Human Services, Marylou Sudders, said in a statement. "MassHealth then suspended all payments to Rite Way and subsequently terminated its contract."

Rite Way, until it ceased operations in 2015, was a fee-for-service transportation company that provided MassHealth members with non-emergency transportation. The company, along with its owner Michael Davini, and former managers Gary Carbonello, Dwayne Pelkey and Lynn Maguire were indicted last week. Mr. Davini, Mr. Carbonello, Mr. Pelkey and Ms. Maguire were all indicted on charges of larceny over $250 and false Medicaid claims, according to the report.

According to the report, Mr. Davini and Mr. Carbonello were also accused of taking kickbacks. Prosecutors said they paid existing clients up to $50 in cash and gift cards to companies including Visa and Dunkin' Donuts in exchange for referring new clients, the report states.

The AG's Office also alleges Ms. Maguire committed perjury by making false statements during her testimony before a Worcester County Grand Jury investigating this matter.

The defendants will be arraigned in Worcester Superior Court.

 

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