Managed care nonprofits must return $10M to federal and state Medicaid programs

May 23, 2024 Brooklyn Eagle Staff

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CITYWIDE — TWO HEALTHCARE COMPANIES that collected millions of dollars in Medicaid payments for services they failed to provide will now have to pay restitution to federal and state Medicaid programs, according to a $10 million settlement reached with New York Attorney General Letitia James. The settlement, with managed-care non-profits RiverSpring Living Holding Corp. and ElderServe Health, Inc. d/b/a RiverSpring at Home (ElderServe) were accused of never providing care to seniors in New York City and surrounding counties during a six-year period starting in 2012. The two managed care companies were supposed to be providing services that were specific to each member’s needs, including home health aide services, nurse visits, social adult day care services, and other community-based services. Instead, in many cases, RiverSpring either did not provide its members with qualifying services or did not adequately document that the services were provided — all the while receiving millions of dollars in Medicaid payments for these services. The settlement is the result of a joint investigation between the Attorney General’s Medicaid Fraud Control Unit and the United States Attorney’s Office for the Southern District of New York. Under the settlement, approximately $6 million will be returned to the New York State Medicaid Program.

A former RiverSpring employee turned whistleblower initiated the case; that person will receive a portion of the settlement, under the qui tam provisions of the federal and New York False Claims Act.

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