Three Buffalo-area nursing homes will repay $9 million after an investigation found they submitted tens of thousands of fraudulent claims to Medicaid to increase their reimbursement rates, New York Attorney General Letitia James announced Monday.
The facilities — Safire Rehabilitation of Northtowns, Safire Rehabilitation of Southtowns and Williamsville Suburban Nursing Home — will pay $6 million to settle Medicaid fraud allegations and an additional $3 million to the federal government for Medicare fraud.
The facilities admitted wrongdoing as part of the settlement.
Nursing homes submitted false data, officials say
A joint investigation by the New York Attorney General's Medicaid Fraud Control Unit and the U.S. Attorney's Office for the Western District of New York found that the facilities submitted
false data between July 2016 and December 2020.
According to investigators, the nursing homes artificially increased the amount of rehabilitative services certain residents were reported to need during periods that affected their Medicaid reimbursement rates. During other periods, the facilities reduced reported rehabilitation services for some residents, regardless of their actual needs.
New York's Department of Health uses information submitted by nursing homes to calculate Medicaid reimbursement rates for claims submitted during the following six months.
The false data resulted in the facilities receiving millions of dollars in Medicaid payments at inflated rates, officials said.
Settlement requires new procedures
Under the settlement, $3.6 million of the $6 million Medicaid payment will go to New York, while $2.4 million will go to the federal government. The facilities will pay an additional $3 million to the federal government related to Medicare fraud.
The nursing homes also must implement new policies and procedures to ensure Medicaid-covered residents receive the services they need and that those services are properly documented.
“Nursing homes that commit financial fraud are stealing funds meant to provide care for our most vulnerable,” James said. “My office has rooted out fraud and resident neglect in nursing homes throughout New York, and we will continue to investigate Medicaid fraud to protect New Yorkers.”
Investigation began with whistleblower complaint
The investigation began after a whistleblower filed a complaint in December 2020 under the qui tam provisions of the New York and federal False Claims acts in U.S. District Court for the Western District of New York.
The New York False Claims Act allows individuals to file lawsuits on behalf of the government and potentially share in any recovery.
Residents and others who suspect Medicaid provider fraud or abuse or neglect at a nursing home can file a confidential complaint with the Attorney General's Medicaid Fraud Control Unit or call its hotline at 800-771-7755. Emergencies should be reported to 911.
This article originally appeared on Rochester Democrat and Chronicle: 3 New York nursing homes to repay $9 million over Medicaid fraud
