Medicaid And Medicare Fraud Investigation Revealed Compassionate Care Hospice Of New York Submitted Reimbursement Claims For Services Not Rendered Or Inadequately Provided
NEW YORK – Attorney General Eric T. Schneiderman today announced that New York State and the United States have entered into a $6 million settlement agreement with a hospice agency regarding allegations that it submitted false and fraudulent claims to the state Medicaid program and Medicare for hospice services not rendered or inadequately provided by Compassionate Care Hospice of New York, LLC (CCH-New York). The settlement, approved today in U.S. District Court by Judge J. Paul Oetken, resolves a joint investigation between Attorney General Schneiderman and U.S. Attorney Preet Bharara.
CCH-New York’s principal place of business is in the Bronx with a satellite office in Brooklyn. CCH-New York is an affiliate and/or subsidiary of Compassionate Care Hospice Group, Ltd (CCH Group). The $6 million settlement will provide $1.68 million back to Medicaid, of which $1.08 will go to New York State. The remainder of the settlement funds will go back to the Medicare program.
“Those who defraud Medicaid are looting from taxpayers and depriving vulnerable New Yorkers of important medical care, and my office will hold them accountable” said Attorney General Schneiderman. “Today’s settlement will recover the Medicaid funds that were improperly obtained, along with extra statutory damages.”
According to the allegations made by the state and federal governments, from May of 2010 through September of 2011, CCH-New York and CCH Group knowingly submitted or caused to be submitted claims for reimbursement to Medicaid for service purportedly rendered by CCH-New York’s Bronx location at 6661 Broadway and received payment thereon for hospice services not rendered or inadequately provided.
As part of the settlement agreement, CCH-New York and CCH Group admitted to the following conduct:
Between May 2010 and September 2011, CCH-New York, at its Bronx location, did not treat certain of its patients according to an individualized plan of care;
Between May 2010 and September 2011, CCH-New York, at its Bronx location, did not adequately maintain a system of communication and integration among its interdisciplinary team, to ensure that plans of care were being followed for each patient;
Between May 2010 and September 2011, CCH-New York, at its Bronx location, failed to make certain nursing services routinely available on a 24-hour basis, 7 days a week;
Between May 2010 and September 2011, CCH-New York, at its Bronx location, failed, in certain instances, to ensure that its nursing services were provided in accordance with the plan of care;
Between May 2010 and September 2011, CCH-New York, at its Bronx location, failed to maintain adequate clinical records;
Between July 2010 and April 2011, CCH Group failed to provide sufficient oversight of CCH-New York’s Bronx location to ensure that the compliance audit results for that location reflected adherence to all applicable regulations.
The agreements – one with the State and one with federal authorities - followed a joint investigation by the Attorney General’s Medicaid Fraud Control Unit and the United States Attorney’s Office for the Southern District of New York. The investigation came after allegations were lodged by a whistleblower who was a former employee at the company’s Bronx location, alleging violations under the New York False Claims Act and federal False Claims Act. Following the investigation, the offices intervened in the whistleblower case and filed their respective Complaints-In-Intervention against CCH-New York and CCH Group. As part of the settlement agreements, CCH-New York and CCH Group entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services’ Office of the Inspector General.
Compassionate Care Hospice of New York, LLC is a for-profit hospice provider with its principal place of business located in Bronx, New York and a satellite office in Brooklyn. Compassionate Care is an affiliate of Compassionate Care Hospice Group, Ltd., an Illinois corporation with its principal place of business in Parsippany, New Jersey, which has subsidiaries and/or affiliates in 22 states, including New York, all of which provide for-profit hospice services.
Attorney General Schneiderman thanks U.S. Attorney Preet Bharara’s Office for its assistance in the investigation.
The state case was handled by Special Assistant Attorney General Jill D. Brenner and Associate Auditor Investigator Deowattie Persaud and former Senior Special Investigator Carlos Miranda, with the assistance of the Supervising Investigator Victor Maldonado and Deputy Chief of Investigations Downstate Kenneth Morgan, Medical Analyst Maureen Kurth, and the late Cassandra Bethel, Chief of Patient Protection, New York City Region. The Medicaid Fraud Control Unit is led by Acting Director Amy Held. The Division of Criminal Justice is led by Executive Deputy Attorney General Kelly Donovan.
Groups audience:
Medicaid Fraud Control Unit
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