Centerlight Healthcare has settled allegations that it collected Medicaid payment for services not provided to adult home residents. Centerlight admitted that 186 adult home residents did not receive their required services during certain months, and also that it failed to dis-enroll residents from its managed long-term care plan in a timely fashion. New York State will receive over $6M of the settlement, with the remainder going to the federal government.
Centerlight administered a managed long-term care plan for Medicaid beneficiaries pursuant to a contract with the New York State Department of Health. To be eligible for enrollment into a long-term care plan, Medicaid beneficiaries must be assessed as needing community-based long-term care for at least 120 days from the date of enrollment. Services include nursing in the home, physical therapy in the home, home health aide services, personal care services, and adult day care. For providing these services, Centerlight received approximately $3,700 per member on a monthly basis. Centerlight allegedly hired agencies that provided a substandard level of care and did not maintain documentation reflecting the provided services
Additionally, 186 patients received no services for several of the months the company billed Medicaid for. The payments resulted from Centerlight not dis-enrolling those members in a timely matter after they had already left the plan.
The fraud was brought to light by whistleblower lawsuit that was filed in 2013 by David Heisler. Mr. Heisler’s award amount has not been determined.
In January 2016, Centerlight settled allegations relating to the use of adult day care centers to enroll ineligible members into the managed long-term care plan. The settlement amount was over $46M. Centerlight sold its managed long-term care plan in 2017.
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