Attorney General James Secures $12 Million and Major Reforms at Syracuse Nursing Home to Stop Resident Neglect and Financial Fraud

NEW YORK – New York Attorney General Letitia James today announced significant reforms and financial penalties for Van Duyn Center for Rehabilitation and Nursing, a nursing home in Syracuse, and its owners and operators, Efraim Steif and Uri Koenig. An investigation by the Office of the Attorney General (OAG) revealed that Steif and Koenig received millions of dollars of taxpayer funds meant for resident care, leaving the nursing home severely understaffed. Residents suffered in unsafe conditions, leading to hospitalizations, deaths, and significant trauma. As a result of OAG’s investigation, Van Duyn and its owners will pay a total of $12 million, including $10 million to directly fund improved resident care and staffing. The OAG will also install an Independent Health Care Monitor (IHM) and an Independent Financial Monitor (IFM) to oversee and improve the nursing home’s health and financial operations. This is the fourth case in which OAG has secured major reforms at nursing homes in New York after investigating resident neglect and abuse. 

“For years, residents at Van Duyn endured unacceptable neglect that caused traumatic injuries and tragic deaths,” said Attorney General James. “We are holding Van Duyn’s owners accountable for these conditions, and ensuring the facility will make all the necessary changes so that its residents get the care they deserve. I will always fight for the dignity and rights of vulnerable New Yorkers and I will continue to go after nursing homes and their owners when they fail to take care of their residents.”

Resident Abuse and Neglect
The OAG’s investigation found that Van Duyn’s residents lived in unsafe conditions before, during, and after the COVID-19 pandemic. Steif and Koenig operated the nursing home with insufficient staffing, resulting in severe neglect of vulnerable residents, who often had no assistance with basic daily tasks. 

• A resident died after Van Duyn failed to properly communicate her care plan to staff, resulting in staff failing to assist her to the bathroom. The resident fell while she was in her room, and her nightgown caught on a door handle, strangling her to death. Nursing home staff were unaware until they later discovered her deceased.
• A resident was found deceased in rigor mortis after Van Duyn failed to appropriately provide care and medication, failed to appropriately assess the resident’s skin upon admission and throughout the resident’s stay, and failed to properly assess the resident after a fall.
• A resident was sent to the hospital after Van Duyn failed to properly monitor and treat their glucose levels.
• A resident was admitted to the hospital with a bacterial infection, bed sores, and dehydration after Van Duyn failed to respond to their rapidly deteriorating condition.
• Multiple residents were inappropriately discharged from Van Duyn and dropped off at a Department of Social Services office without identification, putting them at serious risk of harm.

Financial Fraud
After purchasing the nursing home in 2013, Van Duyn’s owners withdrew tens of millions of dollars for themselves by taking out a mortgage on Van Duyn’s property and charging the nursing home fraudulently inflated rental payments. From 2015 to 2022, the nursing home paid its owners an inflated rent using Medicare and Medicaid funds, resulting in fewer resources available to adequately staff and maintain the facility. The OAG’s investigation also found that Steif and Koenig transferred over $2 million to themselves over the same period by fraudulently paying themselves salaries for work, at least some of which they never performed.

Penalties and Reforms

Financial penalties
Under a settlement with OAG, Van Duyn’s owners must pay $12 million, including $2 million in restitution to New York’s Medicaid program and $10 million to a Resident Care Fund that will be used to support reforms to the nursing home recommended by the independent monitors.

Independent Health Care Monitor
Van Duyn’s owners must pay for and appoint an IHM to oversee all health care operations at the facility and ensure the nursing home improves resident care. The IHM will make recommendations that Van Duyn must implement, including raising staff pay, to ensure the nursing home consistently operates with sufficient staff levels to provide all required care to the existing and future residents. The IHM must also be consulted before Van Duyn hires any administrator or medical director. Van Duyn faces a penalty of $5,000 per day if it fails to implement a recommendation from the IHM in a timely manner.

Independent Financial Monitor
Van Duyn’s owners must pay for and appoint an IFM to oversee Van Duyn’s finances, ensure compliance with the OAG’s settlement and the law, and prevent future fraud. The IFM will also oversee the Resident Care Fund and only approve disbursements from it that are consistent with the IHM’s recommendations. The payments for the independent monitors cannot come from the nursing home’s operating account or the fund established for resident care.

Chief Compliance Officer
Van Duyn must appoint a Chief Compliance Officer responsible for ensuring the IHM’s recommendations are fully implemented, and that Van Duyn complies with all federal and state laws to prevent future resident mistreatment, neglect, and financial fraud.

Other Reforms
Van Duyn and its owners are prohibited from closing or selling the nursing home for at least five years. They also must continue to operate the nursing home at the staffing and supervision levels recommended by the IHM for at least two years after the end of the settlement terms, and they are subject to a $1 million penalty if they violate this duty.

During the course of OAG’s investigation, Van Duyn and its owners failed to produce timely and complete information in response to subpoenas. A court compelled Van Duyn to comply with OAG’s subpoenas, and as a result, the settlement also requires Van Duyn and its owners to fully cooperate with the IHM and IFM, and fully and promptly cooperate with any OAG investigation.

Attorney General James is a leader in stopping fraud and abuse in nursing homes and securing meaningful reforms to protect vulnerable residents. In addition to Van Duyn, six New York nursing homes across the state are under the oversight of IHMs appointed because of Attorney General James’ investigations. To date, Attorney General James has secured over $70 million from nursing home owners and operators.

In November 2024, Attorney General James secured a $45 million settlement and independent monitors at four nursing homes owned and operated by Centers for Care. In March 2024, Attorney General James secured $8.6 million and independent monitors at the Fulton Commons nursing home on Long Island. In December 2022, Attorney General James sued Cold Spring Hills Center for Nursing and Rehabilitation for diverting millions of dollars in funding from resident care, causing widespread resident neglect and abuse. A judge granted OAG’s request for an IHM to oversee Cold Spring Hills in March 2024. 

“What happened at Van Duyn is heartbreaking and infuriating. Families entrusted this facility with the care of their loved ones, only to see that trust betrayed while owners pocketed millions in taxpayer dollars,” said Senator Chris Ryan. “Syracuse seniors and their families deserve dignity, safety, and compassion — not neglect and abuse. I applaud Attorney General James for holding Van Duyn accountable and ensuring that oversight, reforms, and resources will now go directly toward resident care. This action sends a clear message: Central New Yorkers will not tolerate exploitation of our most vulnerable neighbors, and those who try will be held responsible.”

“The residents of Van Duyn and their families deserved care, compassion, and dignity, not neglect and exploitation,” said Assemblymember Pamela Hunter. “This settlement is an important step toward ensuring accountability and restoring trust, but most importantly, it puts safeguards in place to protect those who cannot protect themselves. We must remain vigilant in defending the rights of vulnerable New Yorkers and making sure taxpayer dollars are used to provide the quality care every resident deserves.”

“The conditions at Van Duyn Center for Nursing and Rehabilitation are horror stories,” said Syracuse Deputy Mayor Sharon Owens. “I thank Attorney General James and her team for taking strong action to both hold the owners accountable and to establish requirements for better care into the future. This is the kind of advocacy and enforcement Syracuse and its residents need.”

Attorney General James encourages anyone with information or concerns about alarming nursing home conditions, or resident abuse or neglect to file a confidential complaint online or call the Medicaid Fraud Control Unit (MFCU) hotline at (833) 249-8499.

The settlement discussions were led by MFCU Deputy Chief of Civil Enforcement Diana Elkind.

The investigation was conducted by a multi-disciplinary investigative team from the MFCU’s Civil Enforcement Division and Syracuse Regional Office, led by Deputy Chief of Civil Enforcement Diana Elkind, Special Assistant Attorneys General Elizabeth Silverman, Irene Bardot, and Tiffany Castleman-Smith; MFCU Chief Auditor Dejan Budimir, Senior Auditor-Investigator Siobhan O’Leary; Detective Supervisor Timothy Bates, Detectives Scott Petucci, Eric Sanchez, Ronald Plocek, and John Collins; and Medical Analysts Stephanie Keyser, R.N. and Jennifer Cronkhite, R.N.  Assistant Solicitor General Margaret Cieprisz represented the Attorney General in the appellate courts.

MFCU’s Civil Enforcement Division is led by Chief Alee Scott. MFCU’s Syracuse Regional Office is led by Director Jane Raven. MFCU’s Detectives are supervised by Assistant Chief Investigator Ronald Lynch. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney. MFCU is a part of the Division for Criminal Justice, which is led by Chief Deputy Attorney General José Maldonado and overseen by First Deputy Attorney General Jennifer Levy.

Attorney General James thanks the New York State Department of Health and Commissioner James V. McDonald, M.D., M.P.H., the New York State Office for the Aging and Acting Director Greg Olsen, the New York State Office of the Medicaid Inspector General and Acting Medicaid Inspector General Frank T. Walsh, and the United States Department of Health and Human Services, Office of the Inspector General, Assistant Special Agent-in-Charge Naomi Gruchacz.

New York MFCU’s total funding for federal fiscal year (FY) 2025 is $70,502,916.  Of that total, 75 percent, or $52,877,188, is awarded under a grant from the U.S. Department of Health and Human Services.  The remaining 25 percent, totaling $17,625,728 for FY 2025, is funded by New York State. Through MFCU’s recoveries in law enforcement actions, it regularly returns more to the state than it receives in state funding.