Home Care Companies Accused of Overbilling Get Managed Care Nod

Two New York home care agencies that received government scrutiny and paid multi-million dollar settlements for false reimbursement claims are being allowed into the state’s managed care system, reports the New York Times.

When New York’s Governor Andrew Cuomo was the state’s attorney general, he conducted an investigation of Medicaid fraud and reclaimed a total of $13.2 million from just two agencies, Excellent Home Care and Extended Home Care.

The investigation was launched when the cost of caring for disabled and elderly people at home more than doubled between 2003 and 2010 to $1.3 billion—even though the system was serving fewer people, according to the Times.


Although Excellent and Extended paid $3.7 million and $9.5 million, respectively, to settle the false claims suits, neither admitted any wrongdoing. Now, both of them have been invited to participate in New York’s new managed long-term care system which has a goal of reducing Medicaid costs.

“I don’t know what an organization would have to do to be disqualified,” Susan Regan, a health care lawyer and member of the state’s public health planing council, told the Times after finding out New York’s Health Department endorsed Excellent to get an expanded license to care for more individuals.

New York has changed its reimbursement system away from a fee-for-service model to managed care plans through which providers are paid a fixed sum for each enrollee, regardless of what is spent on services.

Extended Home Care lobbied to provide one of the state’s managed long-term care plans and was awarded HMO status by the health commissioner three months ago, the Times reports.
“We earned this approval, and the support we received for our application, on the merits,” Vincent Achilarre, Extended CEO, told the Times, citing his company’s “high-quality care, delivered with compassion and understanding for our patients’ needs.”

Written by Alyssa Gerace