On August 17, New York State Attorney General Janet Joy announced that three nursing homes in the Buffalo area of upstate New York have agreed to pay a total of $9 million in fines for allegedly submitting false claims to government healthcare assistance programs, commonly known as Medicaid. Of the total amount, $6 million will be used to repay Medicaid funds, while another $3 million will be paid to the federal government.
The three nursing homes involved are all under the Safire company. The Medicaid Fraud Control Unit (MFCU) of the State Attorney General’s Office and the Western District of New York U.S. Attorney’s Office conducted a joint investigation and found that these facilities submitted tens of thousands of false claims between July 2016 and December 2020, resulting in profits of millions of dollars.
According to the investigation, nursing homes are required to accurately report the medical and rehabilitation services needed by residents to the New York State Department of Health, which then calculates their Medicaid reimbursement standards based on the relevant information. Investigators alleged that institutions under Safire intentionally inflated the rehabilitation services needed by many residents to increase Medicaid reimbursement amounts. Alternatively, without affecting the reimbursement rate, they reduced the actual rehabilitation services received by some elderly residents and did not provide services according to their actual needs.
The settlement agreement indicates that the three nursing homes have admitted to the misconduct. In addition to the $9 million fine, they must establish new management and reporting systems to ensure that Medicaid residents receive the necessary services, accurately document the services provided, and prevent similar issues from occurring again.
The Attorney General’s Office stated that the focus of this case is not only to recover improperly obtained public healthcare funds but also to ensure that nursing home residents receive rehabilitation and nursing services according to their needs.
To report any wrongdoing, the State Attorney General’s Office hotline is 800-771-7755.