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SaVida Health settles false billing allegations with $2 million payment

LEGAL NEWSLINE

Thursday, December 19, 2024

SaVida Health settles false billing allegations with $2 million payment

State AG
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Massachusetts Attorney General Andrea Joy Campbell | Twitter Website

Attorney General Andrea Joy Campbell has announced a $2 million settlement with SaVida Health, P.C., a physician group focused on behavioral health and substance use treatment services in Western Massachusetts. The settlement addresses allegations that the organization submitted false claims to MassHealth and its managed care entities by billing for more expensive office visits than were provided and for medically unnecessary urine drug tests.

Under the terms of the agreement, SaVida will pay $2 million in restitution to the Commonwealth. Additionally, it will implement a three-year independent compliance monitoring program at its own expense. This program includes updated policies and procedures to ensure adherence to MassHealth requirements, staff training on these updates, and annual record and on-site audits.

SaVida operates four locations in Western Massachusetts: Worcester, West Springfield, Pittsfield, and North Adams.

"My office will continue to enforce our laws so that providers play by the rules and crucial taxpayer-funded resources are protected," stated AG Campbell. "I am proud to announce this settlement, which will provide meaningful restitution of public resources to the Commonwealth and ensure compliance with state laws that enable the MassHealth program to work for all who depend on it."

The Attorney General's Office (AGO) alleges that since at least 2018, SaVida "upcoded" many Evaluation and Management office visits by billing for more expensive levels of service than provided. Furthermore, it is alleged that SaVida billed for routine confirmatory urine drug tests not deemed medically necessary. According to MassHealth guidelines, confirmation tests should only be performed when positive results from a drug screen require further investigation.

Assistant Attorney General Natalie Rutkowski handled this case alongside Senior Healthcare Fraud Investigators Erica Schlain and William Welsh from the AGO’s Medicaid Fraud Division.

This case is part of AG Campbell's ongoing efforts to hold accountable those who misuse authority or public trust within industries like behavioral health. In October, her office announced a $650,000 settlement with Evolve Health, P.C., over similar allegations involving false billing practices related to substance use disorder treatment.

The AGO’s Medicaid Fraud Division is certified annually by the U.S. Department of Health and Human Services as a Medicaid Fraud Control Unit responsible for investigating healthcare provider fraud against MassHealth. It also investigates abuse or neglect complaints involving residents in long-term care facilities or Medicaid patients across various healthcare settings.

Funding for Massachusetts' Medicaid Fraud Division comes primarily from federal sources—75 percent through a grant totaling $5,922,320 for fiscal year 2025—with the remaining 25 percent funded by Massachusetts itself.

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