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DOJ Catch of the Week -- CenterLight Healthcare

Posted  January 22, 2016

By the C|C Whistleblower Lawyer Team

This week’s Department of Justice “Catch of the Week” goes to New York-based CenterLight Healthcare, Inc. and CenterLight Health System, Inc.  Yesterday, the companies agreed to pay $46.7 million to resolve allegations that they violated the federal and New York State False Claims Acts by enrolling ineligible members in their Medicaid managed long-term care plan.  Specifically, the government charged CenterLight with improperly billing the New York Medicaid program for more than one-thousand members who did not meet the criteria of the managed care plan.  The government also claimed CenterLight engaged in improper marketing practices to enroll members through social adult day care centers and induced them to use the day care centers as their primary source of personal care services.  See DOJ Press Release and New York AG Press Release.

In order to qualify for enrollment in a Medicaid managed long term care plan, Medicaid beneficiaries need to be eligible for a nursing home level of care and require at least 120 days of community-based long-term care, which includes personal care services.  CenterLight admitted that 1,241 of their managed long-term care members were not so eligible.  Centerlight further admitted that the social adult day care centers with which it contracted to provide personal care services for these members did not actually provide services that qualified under Medicaid or were not legally permitted to provide the services.  The government noted that Centerlight continued with its scheme even after the New York State Department of Health issued guidance in early 2013 explicitly stating that an individual’s attendance at social adult day care centers does not satisfy the long-term care eligibility standard.

In announcing the settlement, Manhattan U.S. Attorney Preet Bharara stressed the government’s commitment “to holding health care providers accountable if they wrongfully seek and receive federal funds.”  Scott J. Lampert, Special Agent in Charge of the Health and Human Services, Office of Inspector General’s New York Region joined in this sentiment: “CenterLight’s conduct compromised the integrity of the Medicaid program by enrolling beneficiaries in a plan for which they were not eligible.  HHS-OIG is committed to holding providers accountable for their practices, and the manner in which care is provided.”  New York Attorney General Eric Schneiderman added: “It’s simple: CenterLight Health Care did not play by the rules.  We won’t tolerate companies that seek to exploit the system for profit.”

While it was curiously absent from the DOJ’s press release (though it was noted in the New York AG release), the allegations against Centerlight originated in a whistleblower lawsuit filed by David Heisler under the qui tam provisions of the False Claims Act.  He will receive a yet-to-be-determined whistleblower award from the government’s recovery.

Tagged in: Catch of the Week, FCA State, Healthcare Fraud, Managed Care, Medicaid, Whistleblower Case, Whistleblower Rewards,