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 it violated the False Claims Act by submitting reimbursement claims while violating several regulations related to the licensure and supervision of staff.
Molina is a managed care health 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 that period, the government contends that Molina and Pathways improperly submitted claims for reimbursement to MassHealth and care entities managed by MassHealth while failing to properly license and supervise mental health center staff, including social workers and psychological associates, and failing to provide and timely document the provision of adequate clinical supervision to clinicians requiring supervision.
The settlement also resolves allegations brought in a lawsuit filed by whistleblowers under the qui tam provisions of the False Claims Act, which allow private parties, known as relators, to bring suit on behalf of the government and to share in 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 matter 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 Massachusetts Attorney General’s Office’s Medicaid Fraud Division.