CenterLight Healthcare will pay $47 million for Medicaid managed care fraud

New York-based managed long-term care organization CenterLight Healthcare has agreed to pay $47 million to settle claims that it fraudulently enrolled more than 1,200 Medicaid beneficiaries in a managed care plan they didn't qualify for.

CenterLight allegedly enrolled beneficiaries to its Select Medicaid Managed Long Term Care Plan referred to the company by local adult day care centers, despite the beneficiaries being ineligible for the plans. The day centers also did not provide services that would qualify for reimbursement from the state, which provides CenterLight with more than $3,000 a month per enrollee in its select plan.

“It's simple: CenterLight [Healthcare] did not play by the rules,” New York Attorney General Eric Schneiderman said in release announcing the settlement.

The company, which also provides skilled nursing, rehabilitation and home health services as CenterLight Health System, will pay approximately $28 million to New York's Medicaid program and $19 million to the federal government. The agreement settles allegations that were self-disclosed, as well as claims made in a whistleblower lawsuit.

CenterLight also will enter into a two-year agreement with a compliance monitor and the state Medicaid Fraud Control Unit as part of the settlement.