Medicare Fraud

A New York-based provider is settling allegations that it switched resident’s Medicare coverage to maximize its reimbursements for nearly $8 million. 

The $7.85 million settlement agreement stems from a civil healthcare fraud lawsuit brought against the Plaza Rehab and Nursing Center, an 816-bed facility in Bronx, NY, and its operator, Citadel Care Centers. The deal was announced late Wednesday by the Department of Justice and U.S. Attorney’s Office for the Southern District of New York. 

Requests for comment left by McKnight’s Long-Term Care News with both Plaza Rehab and Citadel were not returned by production deadline. 

The federal agencies say between September 2016 and February 2019 Citadel pressured Plaza Rehab staff to increase the number of residents enrolled in original Medicare in order to increase their reimbursements. Plaza staff allegedly then disenrolled many residents from their self-selected Medicare Advantage plans and enrolled them into Medicare without getting consent from the residents or their representatives “in many instances.” 

In other cases, federal investigators accused staff of discussing disenrollment with a resident and “purportedly obtained the resident’s consent” even though the patient didn’t have the capacity to provide consent because of their health condition, authorities said. 

“Plaza Health Rehab and Citadel often did not offer Plaza Rehab Center residents assistance in re-enrolling them in a Medicare Advantage Plan upon discharge from the Plaza Rehab Center facility,” investigators said. “As a result of the conduct described above, the government made payments under original Medicare to Plaza Rehab Center for residents who were improperly enrolled in Medicare without their consent. Plaza Rehab Center was not entitled to those payments.” 

Plaza and Citadel both “admit, acknowledge and accept responsibility” for the accusations under the settlement agreement in addition to paying $7.85 million, federal investigators said

Citadel also agreed to take steps to ensure that all skilled nursing facilities the company operates comply with applicable guidance on Medicare health plan enrollments. The provider also agreed to enter  into a Corporate Integrity Agreement with the federal government, which requires that they maintain a compliance program.