Press Release: 6/11/2025

AG’s Office Secures Indictments Against Randolph Autism Service Provider For Allegedly Submitting More Than $1 Million In False Claims

 

Provider Was Allegedly Paid by MassHealth for Services Not Provided; Fabricated Documentation to Support False Claims

FOR IMMEDIATE RELEASE:

6/10/2025

MEDIA CONTACT

Allie Zuliani, Deputy Press Secretary

 Phone

Call Allie Zuliani, Deputy Press Secretary at (617) 727-2543

 Online

Email Allie Zuliani, Deputy Press Secretary at Allie.Zuliani@mass.gov

RANDOLPH — The Massachusetts Attorney General’s Office (AGO) today announced that the Statewide Grand Jury has returned indictments against Patrice Lamour and her two Randolph-based companies, Lamour by Design (LBD) and Lamour Community Health Institute (LCHI), for fraudulently billing MassHealth, the state Medicaid program, more than $1 million for services that were never provided. Lamour, LBD, and LCHI were each indicted on one count of Medicaid False Claims and one count of Larceny over $1,200.

LBD primarily received payment from MassHealth for Applied Behavioral Analysis (ABA), which is a treatment principally designed for children with autism spectrum disorder. ABA services focus on the analysis, design, implementation, and evaluation of social and other environmental modifications to produce meaningful changes in behavior. While many of the services are delivered by paraprofessional staff, often referred to as behavioral technicians, MassHealth and its managed care entities (MCEs) require that supervision of behavioral technicians and family training be conducted by Licensed Applied Behavioral Analysts (LABAs).  

The AGO began investigating this matter after a referral by MassHealth. According to the AGO’s investigation, LBD billed for certain supervision and family training services that could not have taken place because the only LABA on staff who could have performed the services was not full-time and stated that he did not perform those services. The AGO also alleges that LBD and LCHI billed for services to members that were not provided, including on holidays and after some members had canceled sessions or terminated services. Further, the AGO alleges that LBD and LCHI employees were asked by Patrice Lamour to bill based on historical data – rather than actual services rendered – and to falsify documentation to suggest that services had occurred when they had not. The AGO alleges that LBD and LCHI, collectively and at Patrice Lamour’s direction, billed and received over $1 million from MassHealth MCEs for ABA and behavioral health services it did not provide. 

These charges are allegations, and the defendants are presumed innocent until proven guilty. 

This case is part of the AGO’s broader efforts to combat fraud by ABA providers. In February, the AGO announced that it had secured a conviction against an Essex County man for stealing more than $33,000 in MassHealth funds for ABA services that were never provided. In October 2023, the AGO announced $2.5 million in recoveries from two settlements with ABA providers who were alleged to have submitted fraudulent claims to MassHealth for services not provided by individuals with appropriate credentials, not properly documented, and/or noncompliant with supervision requirements established by MassHealth and its MCEs.

This matter was handled by Assistant Attorneys General Katie Davis and Sean Hildenbrandt, Investigator Julia Galvao, and Senior Healthcare Fraud Investigators Vanessa Asiatidis and William Welsh, all of the AGO’s Medicaid Fraud Division. MassHealth and its managed care entities and the Department of Public Health provided substantial assistance with the investigation.

The AGO’s Medicaid Fraud Division is a Medicaid Fraud Control Unit, annually certified by the U.S. Department of Health and Human Services to investigate and prosecute health care providers who defraud the state’s Medicaid program, MassHealth. The Medicaid Fraud Division also has jurisdiction to investigate and prosecute complaints of abuse, neglect and financial exploitation of residents in long-term care facilities and of Medicaid patients in any health care setting. Individuals may file a MassHealth fraud complaint or report cases of abuse or neglect of Medicaid patients or long-term care residents by visiting the AGO’s website.   

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 $5,922,320 for federal fiscal year 2025. The remaining 25 percent, totaling $1,974,102 for FY 2025, is funded by the Commonwealth of Massachusetts.