Managed care plan to pay $46.7M to settle fraud allegations

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CenterLight Healthcare and CenterLight Health System have agreed to a $46.7 million settlement to resolve claims the companies enrolled ineligible members in the CenterLight Healthcare managed long-term care plan, according to the Department of Justice.

In 2013, the New York State Department of Health issued guidance stating than an individual's attendance at social adult day care centers does not satisfy the managed long-term care plan eligibility standard. After the guidance was issued, CenterLight improperly billed the New York Medicaid program for 1,241 members whose needs did not meet the criteria of the managed care plan, according to the DOJ.

In the settlement agreement, CenterLight admitted its conduct was improper and agreed to comply will all contractual and regulatory requirements governing the enrollment, assessment, re-assessment and dis-assessment of CenterLight managed long-term care plan members.

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