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Post date: March 9 2015

A.G. Schneiderman Announces Settlement With Rockland County Mental Health Facility That Altered Records Prior To A Medicaid Audit

Mental Health Association of Rockland County Agrees to Pay $304,000, Resolving Penalty Claims Under the NYS and Federal False Claims Acts

Schneiderman: Any Attempt To Undermine Medicaid Funds Will Be Investigated Aggressively By My Office

NEW YORK – Attorney General Eric T. Schneiderman today announced that Mental Health Association of Rockland County, Inc. agreed to pay $304,000 to resolve claims that its managers and employees altered records in advance of a Medicaid audit. In a settlement agreement, MHA Rockland admitted that handwritten changes to records were made prior to the audit so that the records would appear to support claims that were submitted by MHA Rockland to New York State's Medicaid program.

“Audits are an important tool in protecting Medicaid funds that should be used to provide health care to millions of New Yorkers,” Attorney General Schneiderman said. “Any attempt to undermine those audits and our Medicaid program will be investigated aggressively by my office.”

MHA Rockland provides a variety of outpatient mental health services to children and adults in Rockland County. In October 2009, the Office of the Medicaid Inspector General (OMIG) began an audit of MHA Rockland's Continuing Day Treatment program for adults. Prior to the audit, OMIG asked MHA Rockland to collect certain records relating to the program, such as progress notes that purported to document the number of hours patients spent in the program each day. Instead of simply collecting the documents, MHA Rockland managers and employees compared the progress notes to claims MHA Rockland submitted to the Medicaid program and then altered the progress notes so that they would appear to support the claims.

In the days preceding the October 2009 OMIG audit, MHA Rockland managers and employees made over 40 handwritten changes to the progress notes. In some instances, hours were added for days for which there previously had been no entry and, in other instances, handwritten entries of "2" hours were changed to "5" hours. After making the changes, MHA Rockland provided the altered progress notes to OMIG auditors. The unaltered progress notes were originally completed between 2003 and 2008.

Under the New York State False Claims Act, the State can recover penalties relating to the creation or use of false records in connection Medicaid claims. The New York State False Claims Act provides for penalties of between $6,000 and $12,000 for each false record. About $250,000 of the $304,000 settlement announced today is to resolve claims for penalties under the New York State and federal False Claims Acts. The remainder of the settlement resolves claims relating to MHA Rockland's failure to have progress notes or treatment plans for certain Continuing Day Treatment program participants in violation of Medicaid program regulations.

The Attorney General would like to thank the Office of the Medicaid Inspector General for its assistance in this case. OMIG is an independent entity created within the New York State Department of Health, which administers New York's Medicaid program. The United States Attorney's Office for the Southern District of New York also assisted with the investigation.

The Attorney General's investigation was prompted by the filing of a whistleblower lawsuit by two former MHA Rockland employees, who will receive a portion of the settlement. The lawsuit is captioned, U.S., State of New York, ex. rel. Dale v. Mental Health Association of Rockland County, Inc., No. 12 Civ. 0468 (KMK).

The case was investigated by Special Assistant Attorneys General Christopher Y. Miller and Susan Bloom of the Medicaid Fraud Control Unit, Special Investigators Kenneth Deis and Lisa McDonald, Senior Special Investigator Frank DiChiaro, Associate Special Auditor Investigator Melissa Stoebling, Auditor Investigator Nevena Ilcheva, and Principal Special Auditor Investigator Jean Moss. The matter was assisted by Supervising Investigator Peter Markiewicz, Chief of Downstate Investigations Kenneth Morgan, and Assistant Chief Auditor Investigator John Regan. The Attorney General’s Medicaid Fraud Control Unit is led by Acting Director Amy Held and is within the Division of Criminal Justice, which is led by Executive Deputy Attorney General Kelly Donovan.

A copy of the settlement can be read here.

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