BROCKTON − A Brockton-based mental health provider has agreed to pay $700,000 in a settlement to resolve allegations that it submitted false claims to MassHealth following an investigation by the Massachusetts Attorney General’s Office.
“The settlement with Luminosity Behavioral Health Services Inc. (Luminosity) resolves allegations that Luminosity billed MassHealth for higher levels of services than it actually provided and billed MassHealth using an additional code that was not applicable to the services it had rendered,” Attorney General Andrea Joy Campbell said in a written statement.
Luminosity Behavioral Health Services Inc., located at 157 Main St., offers outpatient mental health and addiction services “for anyone struggling to cope with life’s challenges,” according to its website.
“More than two million Massachusetts residents rely on the public funds available in the MassHealth program to cover essential health care services, including critical mental health services,” Campbell said. “My office will continue to stand up for vulnerable communities in need of such services, protect public funds and uphold the integrity of the MassHealth program.”
The AG’s office said the investigation began with a referral from MassHealth and its managed care entities. The investigation found that Luminosity submitted claims to MassHealth and MassHealth managed care entities by “using billing codes that overstated the length, extent, and scope of services it furnished to MassHealth members and falsely inflated the amount of payment claimed for these services,” the statement says.
The attorney general’s investigation also found that Luminosity knowingly submitted claims to MassHealth and managed care entities for services using a certain billing code when the services rendered did not meet the description for that code.
In addition to the financial settlement, under the terms of the agreement, Luminosity has agreed to implement a three-year independent compliance monitoring program at its own expense, which will result in updates to its policies and procedures, new trainings for employees and periodic audits to ensure that it comes into compliance with federal and state law, the AG’s office said.
This matter was handled by Assistant Attorney General Matthew Jones, Senior Healthcare Fraud Investigator William Welsh and investigator Julia Galvao, all of the AG’s Medicaid Fraud Division. MassHealth and its managed care entities provided substantial assistance with the investigation.
The Massachusetts Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $5,865,996 for federal fiscal year 2024. The remaining 25 percent, totaling $1,955,330 for FY 2024, is funded by the Commonwealth of Massachusetts, according to the AG’s office.
Staff writer Kathy Bossa can be reached by email at kbossa@enterprisenews.com. Support local journalism by purchasing a digital or print subscription to The Enterprise today.
