Centers Plan for Healthy Living (“Centers Plan”), a Staten Island-based company that provides services to people who are chronically ill or who need long-term health care services, has agreed to pay $1,650,000 to settle civil fraud allegations that Centers Plan billed the Medicaid Program for services that it did not provide to Medicaid beneficiaries. The settlement agreement, which resolved claims under both the Federal and New York State False Claims Acts, was approved yesterday by United States District Judge Eric N. Vitaliano.
“When health care providers engage in fraudulent billing practices to improperly obtain Medicaid funds, they jeopardize the very integrity of Medicaid, a critical program that provides health coverage to millions of Americans,” stated United States Attorney Donoghue. “This Office will continue to vigorously prosecute those who seek to exploit Medicaid for their own enrichment.” Mr. Donoghue thanked the Medicaid Fraud Control Unit of the Office of the New York State Attorney General and the Office of the Inspector General of the U.S. Department of Health and Human Services for their assistance in the investigation.
The government’s investigation revealed that, from April 2013 through December 2015, Centers Plan fraudulently enriched itself at the expense of Medicaid by knowingly and systematically submitting false claims for payment to Medicaid. In one scheme, Centers Plan improperly enrolled into its managed long-term health care plan individuals who were actually only eligible for Social Adult Day Care or transportation services. In another scheme, Centers Plan failed to disenroll members from its managed long-term health care plan who were no longer receiving qualified community-based long-term care services.
The allegations were brought to the government’s attention through the filing of a complaint pursuant to the qui tam provisions of the False Claims Act. Under the Act, private citizens can bring suit on behalf of the United States and share in any recovery.
The United States’ case is being handled by Assistant United States Attorney Joseph A. Marutollo of the Office’s Civil Division.
E.D.N.Y. Docket No. 14-CV-6129 (ENV)