Rockland Nonprofit Charged with Forging Medicaid Claims and Lying in Medicaid Audit

The nonprofit Mental Health Association of Rockland County, Inc. has agreed to settle with the New York State Office of the Attorney General for $304,000 in response to allegations that the nonprofit altered Medicaid records. In its settlement agreement, the nonprofit admitted to the allegations and accepted responsibility for its actions.

Medicaid is a state and federal taxpayer-sponsored program in the state of New York. Nonprofits that provide healthcare services to vulnerable and indigent populations such as those with mental health issues are eligible for funding from Medicaid. Medicaid funds can only be used to cover services and equipment associated with its mission. Ancillary costs and fees, such as rent or payroll, cannot be covered with Medicaid funds. Generally the facility will bill Medicaid directly for visits, treatment, procedures, services, and more. Medicaid then reimburses the facility.

Mental Health Association of Rockland County overcharged Medicaid for patient visits by inflating the number of hours that patients spent at the health center. In order to bill Medicaid for patient visits, the health center documented the number of hours spent in the Continuing Day Treatment Program, a mental health treatment program for adults, each day.

cash.jpgThe health center was able to continue this practice undetected until the Office of the Medicaid Inspector General initiated a routine audit in 2009 of the Continuing Day Treatment Program. The Inspector requested all records relating to this program, including records that logged the number of hours each patient spent in the program. In order to match the number of hours submitted to Medicaid for billing purposes with the number of hours logged in the records, the managers and employees began altering and falsifying records to inflate the number of hours reported in the log books. For instance, on some forms, days and hours were added; on other forms, the employees changed the number of hours logged. In all, over 40 changes were made to these records. After combing through the records and making handwritten changes, the health center then provided the revised notes to the auditors. The records encompassed years 2003 to 2008.

Despite the glaring discrepancies and alterations on the audit, it was not until two former health center employees reported the Medicaid fraud via a whistleblower lawsuit that the Office of the Medicaid Inspector General and the New York State Office of the Attorney General’s Medicaid Fraud Control Unit began investigating the allegations. The Attorney General then found evidence that the health center had altered the records so that they would appear to support Medicaid claims submitted between 2003 and 2008.

The whistleblower statute in New York is known as the New York False Claims Act. Parties are liable under this statute when they present false or fraudulent claims, such as false Medicaid claims, to the state or local government. Private plaintiffs, known as whistleblowers, are able to file lawsuits under this act. Whistleblowers are usually current or former employees with inside information about the organization’s practices. The offender must pay fines for each violation, as well as damages up to three times the amount of the actual harm. The whistleblower is rewarded for reporting the violations by receiving 15 to 25% of the damages if the Attorney General intervenes. If the Attorney General does not intervene, then the whistleblower can receive a whopping 25 to 30% of the recovery. In addition, this statute protects the whistleblowers from retaliation from current and former employers.

The underlying whistleblower case filed by ex-employees has been resolved as part of this settlement agreement. Mental Health Association of Rockland County is to pay $250,000 for the violations done under state and federal False Claims Acts. In addition, the health center is to pay $54,000 for failing to keep any notes, records, or treatment plans involving various Continuing Day Treatment Program participants who were funded by Medicaid.

If you or a loved one is being abused by a facility funded by Medicaid, you have options. You can report the suspected abuse to the New York State Office of the Attorney General. You can also call the New York Medicaid abuse lawyers at Gallivan & Gallivan today to discuss your potential claim.

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