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Long-Term Care Provider Agrees to $10M Settlement Over Medicaid Billing

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A New York health care provider under investigation for improper Medicaid payments for long-term care services that were never provided has agreed to a $10 million settlement, state and federal prosecutors announced Wednesday.

CenterLight Healthcare admitted as part of its agreement with the offices of Attorney General Eric Schneiderman and U.S. Attorney Geoffrey Berman that on top of getting paid for services that it did’t provide, it also failed to unenroll the residents in its managed long-term care plan for which it was paid by Medicaid.

“CenterLight Healthcare collected millions of dollars in Medicaid payments to provide long-term care services to adult home residents in its managed care plan, but frequently failed to deliver these services,” Berman said in a statement. “This Office is committed to holding recipients of government health care funds accountable when they fail to provide the care and services the government pays them to provide.”

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Between 2012 and 2015, CenterLight provided long-term care for Medicaid beneficiaries through a contract with the state’s Department of Health. To be eligible, patients are required to need community-based long-term care services for more than 120 days from when they enroll in a plan. These services include home-based nursing services and therapies, home health aide services, and adult day care.

CenterLight’s role was in providing these services. In exchange, it received monthly payments between approximately $3,600 and $3,800 per member. The company then contracted licensed service providers to provide the needed care to hundreds of adult home residents enrolled in its plan. The investigation found, according to government authorities, that CenterLight was not properly overseeing that the services were actually being provided to its clients. For the 186 members at issue in the settlement, some never received any care they were signed up for during the months they were enrolled in CenterLight’s managed care plan, according to investigators.

“When a care provider submits phony bills to Medicaid, they rip off New Yorkers and undermine the integrity of our Medicaid system,” Schneiderman said in a statement. “Today’s settlement should serve as another reminder that we will hold accountable those who seek to game the system for their own benefit.”

Wednesday’s settlement has its roots in a qui tam whistleblower claim brought against CenterLight in February 2013. There, the company ultimately settled over claims of improper enrollment and service provided to members of its long-term care plan. The government intervened in that suit, and entered into a separate $46.7 million settlement in January 2016 over the claims. The company sold its long-term care plan in early 2017.

Ropes & Gray partner Stephen Warnke represented CenterLight in the matter. He could not be reached for comment.

— Read Home Care Recipient: Medicaid Fraud Is Not a Victimless Crime on ThinkAdvisor.

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