State Medicaid Probe Obtains $7 Million Repayment

Attorney General Spitzer today announced that Americare Certified Special Services, Inc. (Americare), a Brooklyn based certified home health agency, has agreed to pay $7 million as part of a resolution of an investigation whether it had improperly billed Medicaid for services rendered to residents in adult homes. Home Health Agencies such as Americare provide health care to persons living in their own homes, and also in "adult homes" which are residential facilities that do not provide skilled nursing care.

The agreement follows an investigation by the Attorney General’s Medicaid Fraud Control Unit ("MFCU") which found that Americare had been overpaid by Medicaid for services rendered from January 1, 1997 through December 31, 2004. Specifically, MFCU found that Americare improperly billed for excessive hours, hours not substantiated as medically necessary, and hours for services that the adult homes were expected to provide without charge to Medicaid.

Americare has ended the practices identified by MFCU and has further agreed to institute a compliance program and an employee code of conduct, including appointing a compliance officer responsible for internal compliance audits, compliance training, and advising Americare and its employees on compliance questions. Americare further agreed to institute and maintain an improved records management system.

The Medicaid recovery in this case is part of Attorney General Spitzer’s continuing efforts to recover Medicaid overpayments lost to provider waste, fraud and abuse.

The Americare investigation was conducted by Special Assistant Attorney General Kiran Heer, Special Investigator Brian Dunne, Special Auditor-Investigators Ida Gutterman and Kristen McMorrow and Regional Chief Auditor-Investigator Jerry Hosinking, under the supervision of Richard Harrow, Regional Director. Paul Mahoney, Chief of MFCU's Civil Enforcement Unit, participated in the settlement of the matter.