N.Y. long-term care plan pays $47M for enrolling ineligible beneficiaries

A managed care organization that specializes in long term care in New York City has agreed to pay $47 million for enrolling ineligible beneficiaries in the plan, according to the New York Attorney General's Office.

As part of the settlement, CenterLight Healthcare admitted to improperly enrolling more than 1,200 individuals in its Managed Long-Term Care Plan, which was contracted by the New York State Department of Health to provide services to members who need more than 120 days of in-home services. The beneficiaries were referred by adult day care centers, and CenterLight used the day care centers to provide personal care services to those ineligible beneficiaries.

CenterLight's managed care plan receives $3,000 per month per member from the state's Medicaid program to cover long-term care costs. New York's Medicaid program will receive $28 million of the settlement, and the federal government will receive $18.7 million. The organization also entered into a two-year compliance agreement with the state's Medicaid Fraud Control Unit.

"It's simple: CenterLight Health Care did not play by the rules," state Attorney General Eric Schneiderman said in the announcement. "We won't tolerate companies that seek to exploit the system for profit. My office will continue to be vigilant in protecting Medicaid against fraud."

The Office of Inspector General has repeatedly identified concerns about states' failure to report information on services provided to Medicaid managed care beneficiaries. By tracking information commonly known as "encounter data," the watchdog agency argues that states could better identify services that were provided unnecessarily. The Government Accountability Office has also pointed to gaps in managed care programs that contributed to $14.4 billion in improper Medicaid payments. Last summer, a Massachusetts audit found $500 million in improper Medicaid payments in which the state paid duplicative claims to managed care organizations.   

For more:
- read the N.Y. attorney general's announcement

Related Articles:
States still fail to report managed care encounter data to prevent fraud
Massachusetts audit uncovers $500 million in improper Medicaid payments
GAO: Medicaid managed care needs better watchdogs

Suggested Articles

The HHS OIG is asking for an additional $23.7 million to support fraud oversight that has benefited from an emphasis on data analytics.

A New York surgeon was sentenced to 13 years in prison for fraud and more physician practice news from around the web.

A federal judge has ruled that the U.S. government’s remaining fraud case against UnitedHealth can move forward.