The Massachusetts Attorney General's Office has announced the conviction of Donald Martel, a 69-year-old resident of Georgetown, for submitting fraudulent claims to MassHealth. Following a five-day trial, Martel was found guilty by an Essex County Superior Court jury on charges of Medicaid False Claims and Larceny over $1,200. He has been sentenced to three years probation and ordered to pay full restitution. Additionally, he must avoid contact with witnesses and is prohibited from engaging in any work or billing related to MassHealth members.
The investigation by the AGO’s Medicaid Fraud Division revealed that between April 8, 2019, and October 22, 2019, Martel submitted false claims for applied behavioral analysis (ABA) services that were not provided. During this period, the patient involved was either incarcerated or in a mental health facility and did not receive the billed services. Evidence presented at trial indicated that Martel misappropriated at least $33,000 in funds from MassHealth.
ABA services are therapeutic treatments prescribed for individuals with Autism Spectrum Disorder. These therapies are covered by MassHealth for children under the age of 21 and include professional counseling and guidance aimed at skill development.
This case is part of Attorney General Campbell’s ongoing efforts to address fraud among ABA providers. In December 2022, the AGO secured $2.5 million through settlements with other ABA providers accused of submitting fraudulent claims to MassHealth.
The case against Martel was handled by Assistant Attorneys General William Champlin and Joanna Staley along with Senior Healthcare Fraud Investigator Heather Dwyer and Investigator Kevin Todd from the AG’s Medicaid Fraud Division. The investigation received significant support from MassHealth, Carelon, the Essex County Sheriff’s Department, Fuller Hospital, and Worcester Recovery Center and Hospital.
The AGO’s Medicaid Fraud Division operates as a certified unit under the U.S. Department of Health and Human Services to investigate healthcare provider fraud within Massachusetts’ Medicaid program. The division also addresses abuse or neglect complaints involving long-term care facilities or Medicaid patients in various healthcare settings.
Funding for the Massachusetts Medicaid Fraud Division includes a grant covering 75 percent of its budget from federal sources amounting to $5,922,320 for fiscal year 2025; while the remaining portion totaling $1,974,102 is provided by state funds.