The Montachusett Regional Transportation Authority (MART), a transportation broker for MassHealth, has agreed to pay $300,000 to resolve allegations that it violated the False Claims Act by submitting reimbursement claims for rides that never happened. As a state Medicaid program, which the federal government jointly finances, MassHealth must provide its members with non-emergency transportation to and from medical appointments that MassHealth covers. MassHealth uses transportation brokers, including MART, to help its members find these rides. MART in turn contracts with third-party transportation companies to provide rides to MassHealth members. MART pays the transportation companies for the rides and submits reimbursement claims to MassHealth for the costs of the rides. In addition, MassHealth’s parent agency, the Executive Office of Health and Human Services (EOHHS), pays MART a management fee for its brokerage services.
The government alleges that, from Jan. 1, 2011 through Dec. 31, 2015, MART submitted reimbursement claims to MassHealth for thousands of rides that MART’s contracted transportation companies did not actually provide. MART’s contract with EOHHS required MART to have “procedures to verify that scheduled trips were performed as authorized and as billed, and that the Transportation Provider performed Consumer trips in a timely and satisfactory manner.” According to the allegations in the settlement agreement, however, MART’s verification procedures were not sufficient to prevent transportation companies from submitting false invoices to MART, resulting in MART then billing the invoiced amounts to MassHealth.
