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.”
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.