BOSTON—The attorney general’s office (AGO) of Massachusetts announced that Union Home Health Care Services, a Worcester, Massachusetts-based group adult foster care (GAFC) provider, and its administrator, Bernice Codjia, age 41, pleaded guilty in Worcester Superior Court to charges related to a scheme to defraud MassHealth, the state’s Medicaid program, of more than $1.6 million.
Codjia was sentenced to one year in the House of Correction, suspended for three years with the condition that she is prohibited from offering or providing services to MassHealth members, as well as billing or supervising billing to MassHealth for three years. Union was ordered to pay restitution in the full amount of $1.6 million, but because the company is no longer in business and is therefore unable to pay back the full amount, Union will pay nearly $300,000 as part of its sentence. The court also ordered Union to no longer offer or provide services to MassHealth members or bill MassHealth.
MassHealth’s GAFC program is designed to provide sufficient assistance to MassHealth members who are elderly or have disabilities to enable them to live independently. GAFC services assist MassHealth members with performing daily life activities, such as eating, bathing, housekeeping and laundry. To be eligible for GAFC services, a registered nurse with the GAFC company must conduct an assessment of the member and attest to their eligibility for GAFC services, which is then submitted to MassHealth. Only after a MassHealth member’s eligibility is established may a GAFC provider begin providing and billing for GAFC services.
In November 2023, a Worcester County Grand Jury indicted Codjia and Union for larceny over $1,200 and Medicaid false claims. The AGO alleged that, during her tenure as Union’s administrator, Codjia used fraudulent nursing assessments and forms to enroll MassHealth members and bill MassHealth for GAFC services that had not been authorized by a registered nurse. The AGO further alleges that Union billed for services it never rendered to MassHealth patients, including periods when those members were receiving treatment from different providers at inpatient facilities. As a result of these schemes, MassHealth paid Union nearly $1.6 million for fraudulent GAFC services.
Trials have been scheduled for the other co-defendants in this case.