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A Fall River pediatrician has agreed to pay $175,000 to settle allegations that he submitted false claims to MassHealth, Massachusetts’ Medicaid program, according to an announcement from the Massachusetts Attorney General’s Office on Wednesday.
Dr. Ali Tural and his practice, Tural Pediatrics, Inc., allegedly billed MassHealth at higher physician rates for services that were actually performed by physician assistants and nurse practitioners, who are reimbursed at a lower rate.
Under MassHealth regulations, services provided by midlevel practitioners such as physician assistants and certified nurse practitioners are reimbursed at 85 percent of the fee paid for physician services. These practitioners are permitted to provide care under a physician’s supervision, but claims must accurately reflect who delivered the service.
The Attorney General’s investigation found that between January 1, 2019, and January 1, 2025, Dr. Tural submitted claims indicating he was the provider even when he had not personally rendered the services, allowing him to receive the full physician reimbursement rate.
In addition to the financial penalty, the settlement requires Dr. Tural to implement a three-year independent compliance monitoring program at his own expense. This program will include developing updated policies and procedures, conducting annual training on federal and state healthcare regulations, and submitting to annual audits with results reported directly to the Attorney General’s Office.
The case represents part of a broader effort to combat Medicaid fraud in Massachusetts, a state with one of the most comprehensive public health insurance programs in the country. MassHealth serves approximately 2.2 million Massachusetts residents, including low-income families, children, pregnant women, and people with disabilities.
Healthcare fraud investigations have intensified nationwide in recent years as government agencies work to protect public health funds. According to the National Health Care Anti-Fraud Association, healthcare fraud costs the nation approximately $68 billion annually, with a significant portion affecting public programs like Medicaid and Medicare.
The case against Dr. Tural began with a referral from MassHealth to the Attorney General’s Medicaid Fraud Division. This division functions as a certified Medicaid Fraud Control Unit, authorized by the U.S. Department of Health and Human Services to investigate and prosecute providers who defraud MassHealth.
Assistant Attorney General Mary-Ellen Kennedy led the prosecution, with support from Investigator Julia Galvao and Assistant Investigators Keira Cooney and Maria Theoharis. MassHealth officials provided substantial assistance throughout the investigation.
The Medicaid Fraud Division operates with 75 percent of its funding coming from the U.S. Department of Health and Human Services, receiving $6,458,176 for the 2026 federal fiscal year. The remaining 25 percent, totaling $2,152,724, comes from the Commonwealth of Massachusetts.
Beyond investigating fraud cases, the division also has jurisdiction over complaints involving abuse, neglect, and financial exploitation of residents in long-term care facilities and Medicaid patients in any healthcare setting. Massachusetts residents can report suspected Medicaid fraud or patient abuse through the Attorney General’s website.
This settlement with Dr. Tural reflects an ongoing commitment by Massachusetts authorities to maintain the integrity of public health insurance programs and ensure that taxpayer dollars designated for healthcare are properly allocated according to established regulations.
Healthcare providers across Massachusetts will likely view this case as a reminder of the importance of accurate billing practices and the potential consequences of improper claims submission to government health insurance programs.
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14 Comments
It’s concerning to see a pediatrician engage in this kind of fraudulent billing behavior. Misrepresenting who provided services in order to receive higher reimbursements is a clear violation of medical ethics and regulations. This settlement underscores the importance of strong oversight and accountability in the healthcare system.
I agree, this case highlights the need for robust auditing and enforcement to prevent healthcare fraud. Protecting the integrity of public health programs is crucial, and this settlement sends a clear message that such misconduct will not be tolerated.
It’s disappointing to see a pediatrician abusing the system in this way. Medical professionals should be putting the wellbeing of their patients first, not their own financial gain. This settlement is a step in the right direction.
I agree, the priority for healthcare providers should be delivering quality care, not maximizing reimbursements through dishonest billing practices. Kudos to the AG’s office for pursuing this case.
Misrepresenting who provided medical services in order to receive higher reimbursements is unethical. This $175,000 settlement sends a strong message that such fraudulent billing practices will not be tolerated.
Absolutely. Holding providers accountable for false claims is important to protect taxpayer funds and maintain the credibility of government healthcare programs.
This case highlights the need for rigorous oversight and auditing of medical billing practices. Falsely inflating claims to receive higher payments undermines the integrity of public health programs. The $175,000 settlement is a meaningful penalty.
You’re right, increased monitoring and accountability are crucial to prevent this type of abuse. Fraud harms both patients and taxpayers, so enforcement actions like this are important deterrents.
Falsely billing public health programs is unacceptable, especially from a medical professional entrusted with caring for children. This $175,000 settlement is an appropriate penalty that should discourage similar fraud in the future.
Well said. Preserving the integrity of Medicaid and other government healthcare initiatives is crucial. This enforcement action demonstrates that there are real consequences for providers who abuse the system.
It’s alarming to see a pediatrician engaging in this kind of fraudulent billing behavior. Exploiting public healthcare programs for personal gain is a serious breach of the public trust. This settlement should serve as a warning to other providers tempted to cut corners.
Absolutely. Healthcare providers have a responsibility to be honest and transparent in their billing practices. This settlement shows that the Massachusetts AG will not tolerate such egregious misconduct.
This is a concerning case of healthcare fraud. It’s good to see the Massachusetts Attorney General take action to hold this pediatrician accountable for falsely billing MassHealth. Accurate claims and proper billing practices are crucial for the integrity of public health programs.
I agree, billing fraud like this undermines public trust in the healthcare system. Glad the AG’s office was able to secure a substantial settlement to deter future misconduct.