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NY health care provider accused of fraud, pays $10M to settle

Allegations of health care fraud can cause serious harm to a health care provider’s reputation. As such, it is not surprising that those who find themselves the subject of an investigation or face accusations of this form of fraud seriously consider accepting a settlement agreement in the hopes that they can move on with business and put the whole ordeal in the past.

Unfortunately, accepting a settlement agreement does not always allow for the accused to move on with his or her practice.

Real life example: Heavy penalties can accompany a settlement agreement

One example involves a health care provider out of New York that recently agreed to pay a $10 million settlement over allegations of Medicaid fraud. The case involves CenterLight Heathcare, a not-for-profit corporation that administered Managed Long Term Care Plans for the New York State Department of Health. The organization arranged various long-term care services for those enrolled in the New York State Medicaid Program. They are accused of enrolling participants that were not eligible for the program, a failure to provide the promised services and a failure to reimburse Medicaid for 186 members that were not promptly removed from enrollment when no longer eligible for services.

In order to move forward with the settlement agreement, CenterLight had to admit that it was paid for services that were not provided and failed to unenroll the aforementioned residents as well as pay the government $10 million.

The case provides an example of the heavy penalties that can come with a settlement agreement. Those that are under investigation or accused of Medicaid or Medicare fraud should actively protect their interests. An attorney experienced in these matters can help.