Erie County Nursing Home Sued For Medicaid Overpayments

Attorney General Spitzer today announced that his office has commenced litigation to recover nearly $1 million in Medicaid overpayments made to an Erie County long-term home health care program. The lawsuit is part of a continuing investigation of Medicaid overpayments to such programs across the State which has resulted in the recovery of over $34 million since 2002.

The lawsuit was filed against Rosa Coplon Jewish Home and Infirmary, a 180-bed Residential Health Care Facility that also operates a Long-term Home Health Care Program ("LTHHCP"). The State's complaint, filed in Albany, alleges that from January 1998 to December 2003, Rosa Coplon improperly received payments for costs that were not lawfully reimbursable under the rules of the Medicaid Program. In New York, LTHHCPs, which provide nursing, personal care and therapy to Medicaid recipients in the recipients' homes, are paid based on their reported costs which are tallied by DOH and used to set the rates that Medicaid pays for each of the services the LTHHCP provides.

The complaint alleges that Rosa Coplon received inflated hourly and per visit rates that improperly included payments for non-reimbursable costs, including expenditures for bad debts, advertising and marketing expenses, certain administrative and capital costs, and identified executive salary and benefit expenses. As a result, it is alleged that Rosa Coplon received a windfall from Medicaid. For example, it is alleged that the inclusion of these costs led to the inflation of Rosa Coplon's 2001 rate for personal care services from the correct rate of $21.81 per hour to $27.36 per hour, resulting in a Medicaid overpayment of $153,155 for such services. Rates for other services were similarly affected. Altogether, the lawsuit seeks repayment of $969,958, plus interest, of Medicaid funds that the State contends Rosa Coplon improperly received.

"The size and complexity of the Medicaid Program can sometimes result in the improper expenditure of taxpayer funds even in the absence of fraud," Spitzer said. "My Office is committed to policing the system, identifying fraud, waste or abuse, and recovering money due the State. We encourage Medicaid providers to voluntarily identify overpayments they have received and we will work with all such providers to develop a reasonable plan of restitution. When such efforts fail, however, this Office will not hesitate to take action to compel repayment and to collect, wherever appropriate, all interest and penalties that might be applicable."

Since 2002, audits conducted by MFCU's Special Projects Unit of 17 nursing homes and their related LTHHCPs have resulted in the recovery of more than $34 million in overpayments made to these facilities. A list of the facilities audited and the amounts recovered from each facility is attached.

These audits are part of Attorney General Spitzer's continuing efforts to recover Medicaid overpayments lost to provider fraud and abuse. During federal fiscal years 1999 to 2004, Spitzer's MFCU led the nation with reported recoveries totaling $228,196,224. MFCU's recoveries in ffy 2004 of $79,479,127 set a national record and its recoveries to date in ffy 2005 have already exceeded $203,000,000. In contrast, MFCU recoveries during federal fiscal years 1995 to 1998 ranged from a low of $5,397,042 to a high of $10,591,197.

The LTHHCP project is being conducted by MFCU's Special Projects Unit and the Rosa Coplon action is being handled by MFCU's Civil Enforcement Unit.

Rosa Coplon LTHHCP is located at 2700 North Forest Road, Getzville, New York.


Attorney General Medicaid Fraud Control Unit -- LTHHCP PROJECT

FACILITY
ADDRESS
DATE SETTLED
RESTITUTION TOTAL
THE WARTBURG HOME Wartburg Place, Mount Vernon, NY 10552
2/1/2002
$344,215
UNITED HEBREW GERIATRIC CENTER 60 Willow Drive, New Rochelle, NY 10805
3/19/2002
$805,055
CABRINI CENTER 542 East 5th Street, New York, NY 10009
4/26/2002
$23,592
ST. CABRINI NURSING HOME 115 South Broadway, Dobbs Ferry, NY 10522
4/29/2002
$467,479
HILLSIDE MANOR REHABILITATION AND EXTENDED CARE FACILITY 182-15 Hillside Avenue, Jamaica Estates, NY 11432
7/8/2002
$9,172,628
HUDSON VALLEY REHABILITATION AND EXTENDED CARE FACILITY 266 Vineyard Avenue, Highland, NY 12528
7/8/2002
$1,968,040
ST JOSEPH'S HOSPITAL NURSING HOME OF YONKERS 81 South Broadway, Yonkers, NY 10701
10/1/2002
$2,529,474
IDEAL SENIOR LIVING CENTER 508 High Avenue, Endicott, NY 13760
6/30/2003
$395,379
LUTHERAN CENTER FOR THE AGING 7 Route 25 A, Smithtown, NY 11787
7/7/2003
$214,565
NATHAN MILLER CENTER FOR NURSING CARE 220 West Post Road, White Plains, NY 10606
1/26/2004
$167,555
WK NURSING HOME 2900 Exterior Street, Bronx, NY 10463
4/19/2004
$1,200,000
JEWISH HOME AND HOSPITAL FOR THE AGED 149 West 105th Street, New York, NY
4/19/2004
$900,000
SHOREFRONT JEWISH GERIATRIC CENTER 6323 Seventh Avenue, Brooklyn, NY 11220
6/8/2004
$3,573,424
FRANCES SCHERVIER NURSING CARE CENTER 2975 Independence Avenue, Bronx, NY 10463
7/23/2004
$9,045,638
PARKER JEWISH GERIATRIC CENTER 1 Delaware Drive, Lake Success, NY 11042
12/2/2004
$2,565,357
CHILD'S NURSING HOME COMPANY 26 Hackett Blvd., Albany, NY 12208
1/21/2005
$1,211,723
HEBREW HOME FOR THE AGED (ELDERSERVE) 5901 Palisades Avenue, Bronx, NY 10471
4/1/2005
$205,711
    TOTAL $34,789,835

 

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