Centers Pays $1.6M Over Alleged Managed Medicaid Fraud in New York

An affiliate of skilled nursing provider Centers Health Care paid a $1.65 million settlement to the New York State and federal governments over allegations that its managed Medicaid plan falsely billed for services.

The Centers Plan for Healthy Living LLC submitted monthly state Medicaid claims of up to $4,300 per member for services that it did not provide, New York attorney general Barbara Underwood claimed in a settlement agreement announced this week.

Buffalo Business First initially reported the news.

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“Submitting phony bills undermines the integrity of our Medicaid system and cheats New Yorkers,” Underwood said in a statement. “Today’s settlement serves as a reminder that we will hold accountable those who seek to game the system for their own financial benefit.”

The Centers Plan operates as a managed long-term care (MLTC) plan, a kind of managed Medicaid option in which insurance providers receive set government reimbursements for each enrolled patient. The plan then covers services such as in-home skilled nursing visits and adult day health care. Underwood’s office claimed that many of the Centers Plan’s members never received these promised services, and that the company collected monthly Medicaid payments despite the fact that certain enrollees did not qualify to participate in the plan.

The $1.65 million settles both a state and federal investigation into the Centers Plan; the whistleblower who alerted authorities about the issue will receive a portion of that money once Centers pays the bill under both the federal and state-level False Claims Act.

A spokesperson for Centers told SNN in a statement that the company has worked cooperatively with both the state attorney general’s office and the Department of Health and Human Services (HHS) Office of the Inspector General (OIG), the federal agency’s top Medicare and Medicaid watchdog.

“As a vibrant and thriving organization, CPHL is in good standing and the company’s overall goal is to provide members and all those involved in their care with the guidance and health plan choices they need for healthy living,” the spokesperson said in an e-mail. “CPHL is committed to providing quality, coordinated health care to some of the most honored and yet still vulnerable members of our community.”

Centers Health Care operates 45 skilled nursing and rehab facilities across the Northeast as well as in Missouri and Kansas, serving about 8,000 residents. Through its Centers Plan for Healthy Living, the company also offers Medicare Advantage and SNF-specific HMO special needs plans (SNPs).

Written by Alex Spanko

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