Managed Care Plan Settles Fraud Case for $47 Million

The state of New York has announced a $47 million settlement with CenterLight Healthcare and CenterLight Health System, effectively resolving claims that the company’s Select Medicaid Managed Long Term Care Plan fraudulently billed Medicaid for services rendered to patients who didn’t qualify for the program.

CenterLight Healthcare’s Select program is a managed long-term care plan that has contracted with the New York State Department of Health to provide long-term community-based health care for members who can stay in their homes without health or safety risks and are expected to need more than 120 days of in-home services, including nursing, therapy, home health and personal care, according to a news release. CenterLight said it billed Medicaid for services provided to 1,241 recipients who didn’t qualify for such services, Attorney General Eric T. Schneiderman said in the release.

As part of the settlement, New York’s Medicaid program will receive $28 million and the United Stated Medicaid program will receive $18.7 million.

“It’s simple: CenterLight Health Care did not play by the rules,” Scneiderman said in a prepared statement. “We won’t tolerate companies that seek to exploit the system for profit.”

Along with its $47 million payment, CenterLight must enter a two-year agreement with an independent compliance monitor and the Attorney General’s Medicaid Fraud Control Unit.

The company further admitted to enrolling Medicaid beneficiaries referred by social adult day care centers despite their ineligibility to receive managed long-term care under the plan, and using the day care centers to provide community-based personal care services that didn’t qualify as personal care services under CenterLight’s Select plan.

The settlement is the second handled by the Attorney General’s Office involving a managed long-term care plan in New York, and it comes as 26 states involved in Medicaid-managed long-term care plans are struggling to roll out such supports and services. Several states have seen costs fluctuate, while others have abandoned their programs entirely.

Home health and home care providers alike increasingly see managed long-term care as a revenue stream, with companies like Addus specifically targeting states that are transitioning to managed care.

Written by Kourtney Liepelt