An independent clinical laboratory and its owner have been indicted in connection with Medicaid fraud and larceny involving urine drug tests that allegedly caused over $400,000 in false claims to be submitted to the Massachusetts Medicaid health insurance program, Attorney General Andrea Joy Campbell announced today.
According to the AG’s Office, Solid Diagnostics, Inc. of Burlington and its owner, Rita Ausiejus of Acton, were indicted by a statewide grand jury last month on two counts each of Medicaid False Claims, Medicaid Reverse False Claims and Larceny over $1,200. They are set to be arraigned in Middlesex Superior Court on March 21.
The AG’s Office alleges that Solid and Ausiejus submitted claims to MassHealth for urine drug tests that were not appropriately ordered by physicians or other authorized prescribers and urine drug tests which were for medically unnecessary residential sobriety monitoring purposes. Under state regulations, laboratories may not bill MassHealth for tests performed at sober homes for residential monitoring purposes because such tests are not medically necessary. By fraudulently billing MassHealth and its managed care entities for these tests, the defendants are alleged to have caused over $400,000 in false claims.
These charges are the latest development in the work of the AG’s Office to address kickbacks and false claims among Medicaid providers, particularly independent clinical laboratories. In December 2022, an independent clinical laboratory agreed to pay $1.5 million to the MassHealth program to resolve allegations by the AG’s Office that it engaged in an illegal kickback relationship with a New Bedford-based clinical laboratory. In June 2022, an investigation by the Medicaid Fraud Division resulted in charges against three independent clinical laboratories, their owner and holding company, an additional independent clinical laboratory and its owner, two laboratory marketing companies, and a Massachusetts physician in connection with Medicaid fraud, money laundering, and kickbacks involving over $2 million in urine drug tests. In May 2022, the AG’s Medicaid Fraud Division secured indictments against an independent clinical laboratory in New Bedford and one of its owners who allegedly conducted an illegal kickback and Medicaid fraud scheme involving urine drug screens at sober homes.
This investigation and prosecution are being handled by Assistant Attorney General Katie Cooper Davis, Senior Healthcare Fraud Investigator Shelby Stephens and Investigator Vanessa Asiatidis, all of the AG’s Medicaid Fraud Division.
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 $5,542,963 for Federal fiscal year 2023. The remaining 25 percent, totaling $1,847,641 for FY 2023, is funded by the Commonwealth of Massachusetts.