Court dismisses $13 million false claims suit over SNF reimbursements

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A New York health system is off the hook for $13 million in Medicaid overpayments incurred by one of its nursing homes, according to a court's recent ruling.

The case was brought against Catholic Health System of Long Island by whistleblower Michael Quartararo, an administrator at the system's St. Catherine of Siena Nursing and Rehabilitation Care Center in Smithtown, NY.

Quartararo claimed that Catholic Health operated St. Catherine for ten years using an outdated Medicaid reimbursement rate assigned to the facility's previous owner, therefore knowingly collecting $13 million in overpayments from the state government.

St. Catherine had submitted an appeal for a new reimbursement rate but was never assigned one, according to an opinion from the U.S. District Court for the Eastern District of New York filed on March 31.

In its dismissal of the case, the court ruled that Quartararo failed to show that Catholic Health falsely certified its Medicaid compliance, as well as that the system's “alleged fraudulent diversion” could be linked to its Medicaid claims.

Judge Margo K. Brodie also noted that the health system told auditors that it was using old reimbursement rates, showing that the state Department of Health could've updated its rates but continued paying the facility's Medicaid claims anyway.