Long-term care provider pays $10.3M to resolve false billing allegations

CenterLight Healthcare and CenterLight Health System agreed to pay $10.3 million to resolve allegations of false Medicaid billing, according to a March 28 news release from the office of New York Attorney General Eric Schneiderman.

State and federal officials specifically allege CenterLight's former managed long-term care plan improperly billed New York's Medicaid program for monthly capitation payments — similar to insurance premiums — for 186 CenterLight MLTCP members and did not make repayments for falsely-obtained payments.

The members lived in adult homes and "for at least some portion of their enrollment in the CenterLight MLTCP, did not receive community-based long-term care services as required by contract and therefore should have been dis-enrolled," according to the release. The AG said CenterLight Healthcare never repaid New York's Medicaid for monthly capitation payments — generally $3,800 to $4,200 per member per month — for many of the adult home members after the dis-enrollment issue came to light.

CenterLight made admissions as part of the settlement agreement. According to the AG, CenterLight acknowledged the adult home members did not receive the required CBLTC services for certain enrollment periods from April 2012 to September 2015.

They also admitted "that for a number of individuals there was no record that they received CBLTC services for most of their period of enrollment," and "that it failed to timely dis-enroll the 186 Adult Home MLTCP members, even though they were no longer eligible for MLTCP services," the release states.

New York's Medicaid program is slated to recover $6.36 million in restitution and penalties as part of the settlement.

The case was originally brought under the qui tam, or whistle-blower, provisions of the federal and New York False Claims Acts.


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