BOSTON — Settlements totaling more than $2.5 million have been reached with two applied behavioral analysis service providers to resolve allegations that the providers submitted fraudulent claims to MassHealth, the attorney general said Tuesday.
The services were principally designed to treat children with autism spectrum disorder, a neurodevelopmental disorder characterized by difficulties in social interaction, impaired communication, and repetitive restrictive behaviors, Attorney General Andrea Joy Campbell said in a statement.
One settlement involves Ubuntu Autism Consultants, LLC, formerly of Worcester, Autism Behavioral Links, Inc., of Framingham, and Ian Gatheca, the owner of both companies.
The settlement requires Ubuntu and Gatheca to pay $1.7 million to resolve allegations that they submitted false claims to MassHealth managed care entities services that were not provided by individuals with the appropriate credentials for the service in question, Campbell said.
The second settlement is with Autism Resources and Therapy Center, of Westboro, and its owner Mary Wangari.
The settlement requires the center and Wangari to pay $825,000 to resolve allegations that they billed MassHealth managed care entities for applied behavioral analysis services that were either not rendered and/or not properly documented, and for failing to provide adequate supervision of the center’s paraprofessional staff, Campbell said.
“The defendants involved in these two settlements not only failed to comply with the necessary standards for providing critical services to a vulnerable population with autism spectrum disorder, but also fraudulently exploited public funds,” said Campbell. “These resolutions ensure that these companies will pay back the money they owe MassHealth and bring themselves into compliance with required state laws and regulations, so our youth receive the high-quality ABA services they deserve.”
In addition to the financial settlements, under the terms of both agreements, both providers have agreed to implement a three-year independent compliance monitoring program at their own expense, which will result in updates to their policies and procedures, new trainings for employees, and periodic audits to ensure compliance with all applicable state and federal laws, Campbell said.
Applied behavioral analysis services focus on the analysis, design, implementation, and evaluation of social and other environmental modifications to produce meaningful changes in behavior, Campbell said.
While many of the services are delivered by paraprofessional staff, often referred to as behavioral technicians, MassHealth and its managed care entities require that treatment planning and family training be conducted by Licensed Applied Behavioral Analysts. MassHealth also requires the licensed behavioral analysts to provide supervision at specified intervals to behavioral technicians.
Campbell’s office began investigating Ubuntu following a referral by MassHealth. The attorney general’s office alleges that Ubuntu billed for services that can only be provided by Licensed Applied Behavioral Analysts even when those services were not provided by a licensed behavioral analyst. Investigators also found that Ubuntu billed for services provided by behavioral technicians, even if those behavioral technicians had not received appropriate supervision from Licensed Applied Behavioral Analysts.
Campbell’s office began investigating Wangari’s business in Westboro following a referral by MassHealth.
The attorney general’s office alleges that Autism Resources and Therapy Center, like Ubuntu, billed for services provided by behavioral technicians who had not received appropriate supervision from a licensed behavioral analyst. Investigators also allege that the Westboro center lacked supporting documentation to substantiate that some of the services it billed had actually been provided.
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