Swansea mental health center sued by AG's office for fraud
Herald News - 1/11/2018
BOSTON - SouthBay Community Services, headquartered in Brockton, is being sued by the Massachusetts Attorney General's office for allegedly billing MassHealth fraudulently for mental health services provided by unlicensed staffers at 17 clinics, including one in Swansea, across the state.
The Swansea clinic at 463 Swansea Mall Drive, a satellite of the Brockton site, was named in the suit for its practices while located in Swansea and previously at 1563 N. Main St. in Fall River, until 2016.
According to the lawsuit, the clinic directors at the Fall River/Swansea clinics were unlicensed. The regional directors lacked the appropriate licenses, and the majority of "supervisors" were unqualified to perform supervision under the regulations.
"This company provided substandard care to many vulnerable patients and fraudulently billed the state for its inadequate services," Attorney General Maura Healey said in a statement. "MassHealth members deserve competent treatment from qualified individuals, and our office will continue to take action in order to remove these significant barriers to accessing critical mental health care in our state.
SouthBay, which continues to see patients, said it "does not agree with the allegations" and plans to "follow the legal steps necessary" to resolve the matter.
"We remain focused on the well-being of our consumers and employees," said SouthBay spokeswoman Gracie Lee in a prepared statement. "Our daily operations have not been affected, and we will continue to provide the best possible behavioral health services to those who need it most in New England."
SouthBay performs psychotherapy for individuals, families and groups, including diagnostic evaluation and interpretation and explanation of results. It offers both inpatient and outpatient services.
The AG's investigation into the allegations began after a whistleblower lawsuit was filed by a former mental health center employee in August of 2015 in the U.S. District Court for the District of Massachusetts.
SouthBay is licensed by the Department of Public Health, the agency responsible for the clinical licensure and regulation of mental health centers. It requires facilities to have qualified clinicians and supervision in mental health centers.
The Herald News sought comment from the Department of Public Health but did not receive a reply by the end of business hours.
According to a press release on SouthBay's website, the organization employs some 1,000 people at its locations.
In Fall River/Swansea, Sarah Hart, director of clinical operations in July of 2014, reviewed staff rosters, which showed that six out of 22, or 27 percent, of SouthBay's unlicensed clinicians were assigned unlicensed supervisors. Also, three clinicians (or 41 percent) were assigned to licensed clinical social worker (LCSW) supervisors, which is considered an insufficient license to act as a supervisor.
In March of 2016, almost two years later, the Fall River/ Swansea clinic was still assigning "clinical supervisors" to unlicensed staff, according to the lawsuit.
Of 100 individuals who worked at the Fall River/Swansea clinics, just two were independently licensed supervisors. The majority of staff therapists were unlicensed and could not have been adequately supervised given the lack of qualified supervisors at the clinic, the law suit said.
The AG's investigation revealed that SouthBay had a widespread pattern of employing unlicensed and unsupervised staff at its facilities in violation of MassHealth regulations. The complaint alleges that it submitted fraudulent claims in violation of the Massachusetts False Claims Act.
Many of the employees who were performing mental health services did not have degrees in social work, and were therefore not even license eligible, the claim states. Instead, they had degrees in areas such as art therapy, school counseling and agency counseling.
MassHealth makes licensure and staffing requirements for mental health services provided to its members.
From August 2009 to the present, MassHealth and its contracted managed care entities paid SouthBay more than $123 million for outpatient services. The AG's office estimates that a significant portion of that amount was based on fraudulent claims to more than 30,000 MassHealth members.
The complaint was filed against the company and Peter J. Scanlon, who founded and owned the company until April 2012. It also names H.I.G. Growth Properties LLC and H.I.G. Capital LLC, and its co-founder Kevin P. Sheehan, which acquired the company from Scanlon.
The AG's office alleges that those parties knew that SouthBay was providing services in violation of regulatory requirements and did not bring operations into compliance or make any attempts to repay the money owed to MassHealth.
The AG's office is seeking treble damages, civil penalties and prejudgement interest. The commonwealth is demanding a trial by jury.
SouthBay opened in 1986 and provides services to more than 35,000 individuals annually, according to the company web site, at 23 locations in Massachusetts, Connecticut and Rhode Island.
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