Yonkers Treatment Program To Repay Medicaid $1.4 Million

Attorney General Spitzer announced today that the Maitri Center Inc., a Yonkers AIDS day treatment program, has agreed to repay the New York State Medicaid Program more than $1.4 million it improperly received from Medicaid.

The Maitri Center is an AIDS adult day health care program which provides social and health services to individuals living with HIV/AIDS. As an AIDS adult day health care program, Maitri provides its patients with case management services, medical and nursing care, dietary instruction, meals, exercise and fitness classes, and other social, therapeutic, and recreational therapies. To qualify for Medicaid reimbursement, Medicaid regulations require that patients attend the program for at least three hours per day and that they also receive at least three hours of health care services per week. Medicaid regulations further require that the program maintain records showing that the patients actually received the claimed services.

The investigation conducted by the Attorney General’s Medicaid Fraud Control Unit (MFCU) revealed that the Maitri Center improperly billed Medicaid for services when the patients: (1) had not been present at the program at all; (2) had not been at the program for the required three hours per day; and/or (3) had not received three hours of required weekly health care services. MFCU also determined that in other instances the Maitri Center failed to maintain records that demonstrated that the patients had attended the program as required.

The Maitri Center fully cooperated with the MFCU investigation and has undertaken reforms to ensure that Medicaid is billed only when services are provided in accordance with Medicaid regulations. Because MFCU determined that the Center’s billing errors were not the result of fraud and further because MFCU determined that the Center lacks the resources to make immediate repayment of this overbilling and that it provides valuable services to a needy population, the settlement agreement allows the Center to repay Medicaid over a period of nine years. The Center will be required, however, to pay Medicaid interest totaling approximately $450,000 over this nine year period.

Special Assistant Attorney General Thom O’Hanlon of the Medicaid Fraud Control Unit’s Pearl River Regional Office brought the case. Special Investigator Frank Fizzignolia, Principal Special Auditor Investigator Ann Winslow and Senior Special Auditor Investigator Sandra Alvarez assisted in the investigation.

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