Company Allegedly Billed MassHealth for More Expensive Services Than They Actually Provided and Failed to Properly Safeguard Patient and Employee Data
BOSTON — Monday, October 19, 2026 – Press Release – (InfoHaïti.net) -Massachusetts Attorney General Andrea Joy Campbell today announced a $1 million recovery from former medical transportation provider Transformative Healthcare, LLC (Transformative) and its former subsidiaries, Lifeline Ambulance Services, LLC and Lifeline Healthcare Solutions, LLC (together, Lifeline) and Fallon Service, LLC and Fallon Emergency Medical Services, LLC (together, Fallon).
The recovery results from a settlement agreement and a proposed consent judgment that will resolve allegations that Lifeline and Fallon submitted false claims to MassHealth and its managed care entities for more expensive services than were provided, violated MassHealth medical necessity requirements, and failed to safeguard patient and employee data.
Transformative was a medical transportation company headquartered in Newton, Massachusetts. Transformative ceased operations in 2022, and Fallon and Lifeline were acquired by a separate medical transportation company in 2022. Pursuant to the settlement, Transformative will pay $1 million over a five-year period.
“Healthcare companies have a responsibility to protect the sensitive patient data they are entrusted with and to bill MassHealth only for the services they provide,” said AG Campbell. “My office will continue to hold companies accountable when they defraud MassHealth and put residents’ personal information at risk.”
An investigation by the Attorney General’s Office (AGO) found that Fallon and Lifeline allegedly falsely “upcoded” their claims to MassHealth by billing for more expensive levels of services than they actually provided. This includes billing for emergency transportation services when only a nonemergency level of service was provided; submitting false claims for Advanced Life Support services when the situation did not meet the regulatory criteria for such service; and submitting claims for services without required medical necessity documentation in violation of MassHealth regulations.
The AGO also conducted a separate investigation into the handling of a breach of Transformative’s data that occurred from February 2023 through April 2023 during an archiving process. The breach potentially impacted the names, addresses, phone numbers, dates of birth, driver’s licenses, state-issued identification card numbers, medical information, insurance information, or Social Security numbers of 750,116 Massachusetts residents who were both patients and employees of Transformative.
The AGO alleges Transformative failed to maintain an appropriate written information security program (WISP) as required by the Massachusetts Data Security regulations and the Health Insurance Portability and Accountability Act. A WISP is a plan to systematically identify and assess reasonably foreseeable security risks and to regularly evaluate and improve the effectiveness of existing safeguards, including proper employee training.
The Medicaid fraud matters in this case were handled by Division Chief Kevin Lownds, Assistant Attorney General Matthew Jones, Senior Data Scientist William Welsh, and Senior Health Care Fraud Investigator Christine Barker of the AGO’s Medicaid Fraud Division. MassHealth provided substantial assistance with the investigation.
The data breach matter was handled by Assistant Attorney General Camy Ruck and Division Chief Jared Rinehimer of the AGO’s Privacy and Responsible Technology Division.
This matter is representative of the AGO’s ongoing efforts to combat MassHealth fraud, including within the medical transportation industry, and to protect residents’ medical information and other sensitive personal data. In January 2026, the AGO announced that it reached a $515,000 settlement with Comstar, LLC, a Rowley-based ambulance billing vendor, for failing to safeguard sensitive patient information during a March 2022 data breach. In August 2025, the AGO announced a $6 million settlement with two Weymouth-based ambulance companies to resolve allegations that the companies submitted false claims to MassHealth for more expensive services than were provided and violated MassHealth medical necessity requirements.
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 $7,107,548 for federal fiscal year 2027. The remaining 25 percent, totaling $2,369,182 for FY 2027, is funded by the Commonwealth of Massachusetts.
