Westfair Online reported a nursing home will pay $2.2 million to the state and federal governments to settle claims of Medicaid fraud.  Ralex Services Inc., which operates the Glen Island Center for Nursing and Rehabilitation on Pelham Road in New Rochelle, and its owner, Leah Friedman, will return the $2.2 million garnered from allegedly submitting more than 62,000 false claims to the joint state and federal program between 2002 and 2006.

“Safeguarding public health care dollars is of critical concern, and my office will investigate — and prosecute — all allegations of impropriety by health care providers who obtain Medicaid funds to which they have no right,” state Attorney General Eric T. Schneiderman said in a press release announcing the settlement. “We must care for our most vulnerable New Yorkers and at the same time protect our taxpayer dollars. Today we are saying: There is one set of rules for all nursing home providers — and my office is here to make sure those rules are followed.”

According to allegations made by the state and federal governments, the nursing home’s claims used Medicaid reimbursement rates based, in part, on up-coded Patient Review Instruments, which falsely represented the degree of care required by many Glen Island residents during the mandatory quarterly assessment periods covered by these submissions. The defendants exaggerated residents’ diagnoses, conditions and required treatments in the reports, according to the press release, and routinely stated that residents were receiving treatments, including for oxygen and suctioning, when such treatments were neither required nor given.

According to the Attorney General’s press release, the defendants attempted to cover up their fraudulent submissions and false claims by making false entries and forgeries into Glen Island residents’ medical records. These falsified records were later turned over to the attorney general’s Medicaid Fraud Control Unit. Two former Glen Island nurses, who participated in “tampering parties” at which records were falsified, were also convicted by the attorney general’s office.

 

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