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Post date: March 23 2006

Rehabilitation Program Repays Millions To Medicaid

Attorney General Spitzer today announced that a Long Island not-for-profit corporation has paid nearly $3 million to New York's Medicaid program to settle allegations that it had, under its former management, billed Medicaid for services delivered by unqualified personnel and for services that were not adequately documented.

Long Island Head Injury Association, Inc. (LIHI) of Commack provides services to survivors of traumatic brain injuries under a Medicaid waiver program specifically created to help severely injured individuals recover and become sufficiently independent to avoid being institutionalized. Pursuant to the settlement agreement, LIHI paid the Medicaid program $2,936,037 for overpayments discovered by an audit of LIHI's billing practices by the Attorney General's Medicaid Fraud Control Unit. That audit revealed that LIHI:

  • Billed Medicaid for services provided by employees who lacked legally required qualifications. In particular, the audit revealed that unqualified persons created service plans and provided training and rehabilitation services;
  • Lacked required documentation to show that the service had, in fact, been provided. Indeed, the audit revealed that LIHI lacked documentation for more than 75 percent of certain services for which it had billed Medicaid.

Attorney General Spitzer noted, "This settlement will ensure that an organization providing critical services to people with severe trauma, can continue to serve the community. At the same time, the investigation has resulted in the recovery of a large amount of taxpayers' money that was spent inappropriately. Not-for-profit programs are not exempt from the law, and they must follow the rules when they are entrusted with public funds."

In response to the MFCU audit, LIHI replaced its chief executive officer and instituted a corporate compliance program. These changes should allow LIHI to move forward in providing critical care to a vulnerable patient population in compliance with State law.

MFCU's audit and investigation was conducted by Special Assistant Attorney General Veronica Bindrim-MacDevitt and MFCU auditors and investigators: Ronald Tysowski, Christopher Simeti, Margaret McArdle, Dawn Scandaliato and Daniel Layer, all of the Long Island Regional Office. Special Assistant Attorney General Sherrie Brown of the MFCU Civil Enforcement Unit assisted in the settlement of the case.