NY Erie County Nursing Home Sued For Medicaid Overpayments

NY.gov, Nov 18, 2005

For Immediate Release: September 28, 2005

Attorney General Eliot Spitzer today announced that his office has commenced litigation to recover nearly $1 million in Medicaid overpayments made to an Erie County long-term home health care program. The lawsuit is part of a continuing investigation of Medicaid overpayments to such programs across the State which has resulted in the recovery of over $34 million since 2002.

Infirmary, a 180-bed Residential Health Care Facility that also operates a Long-term Home Health Care Program ("LTHHCP"). The State’s complaint, filed in Albany, alleges that from January 1998 to December 2003, Rosa Coplon improperly received payments for costs that were not lawfully reimbursable under the rules of the Medicaid Program. In New York, LTHHCPs, which provide nursing, personal care and therapy to Medicaid recipients in the recipients’ homes, are paid based on their reported costs which are tallied by DOH and used to set the rates that Medicaid pays for each of the services the LTHHCP provides.

The complaint alleges that Rosa Coplon received inflated hourly and per visit rates that improperly included payments for non-reimbursable costs, including expenditures for bad debts, advertising and marketing expenses, certain administrative and capital costs, and identified executive salary and benefit expenses. As a result, it is alleged that Rosa Coplon received a windfall from Medicaid. For example, it is alleged that the inclusion of these costs led to the inflation of Rosa Coplon’s 2001 rate for personal care services from the correct rate of $21.81 per hour to $27.36 per hour, resulting in a Medicaid overpayment of $153,155 for such services. Rates for other services were similarly affected. Altogether, the lawsuit seeks repayment of $969,958, plus interest, of Medicaid funds that the State contends Rosa Coplon improperly received.

These audits are part of Attorney General Spitzer’s continuing efforts to recover Medicaid overpayments lost to provider fraud and abuse. During federal fiscal years 1999 to 2004, Spitzer’s MFCU led the nation with reported recoveries totaling $228,196,224. MFCU’s recoveries in ffy 2004 of $79,479,127 set a national record and its recoveries to date in ffy 2005 have already exceeded $203,000,000. In contrast, MFCU recoveries during federal fiscal years 1995 to 1998 ranged from a low of $5,397,042 to a high of $10,591,197

Department of Law:

The State Capitol
Albany, NY