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Centerlight Health System to Pay Nearly $60 Million in Whistleblower Billing Fraud Case

Centerlight Health System, Inc., a New York-based healthcare provider primarily serving elderly and disabled Medicaid patients, reached a new $10.3 million settlement in a case with state and federal elements over long-term care payments made to residents of adult homes, even if they were not eligible for coverage.

Centerlight will pay this amount in addition to a 2016 agreement that requires it to pay $46.8 million to resolve similar allegations brought forth by a whistleblower.

Wrongdoing included false claims

In this most recent settlement, the federal government claimed Centerlight had submitted false claims for payments of between $3,800 to $4,200 each for 186 residents who occasionally did not receive the community-based long-term care services needed for them to be eligible for Medicaid. The government also accused the company of not removing these ineligible patients from its rolls for a period of nearly three and a half years from April 2012 to September 2015. Centerlight was responsible for ensuring these services were provided to all Medicaid enrollees, but often did not do so, according to court documents.

The whistleblower who raised similar concerns several years ago in a case against Centerlight also filed another similar lawsuit against the Visiting Nurse Service of New York, a case that resulted in a $35 million settlement in November 2014. That company reached a $4.4 million follow-up agreement with the federal government in July 2017.

Medicare and Medicaid fraud leads to billions of dollars in waste and theft every single year, and it is through the services of whistleblowers that many of these schemes get uncovered. For more information on how to proceed with your whistleblower claim, speak with a trusted Dallas attorney at Kardell Law Group.

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