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Community Options, Medicaid Fraud, New York 2024
In a damning indictment of the state of healthcare in New York, Community Options, a not-for-profit corporation operating a network of residential and non-residential facilities and programs for adults with developmental or intellectual disabilities, has been forced to pay out $5 million in a settlement over allegations of Medicaid fraud.
As part of the settlement, Community Options will pay the U.S. $2,148,540.37 and have admitted and accepted responsibility for certain conduct alleged in the Complaint, including failing to maintain adequate policies concerning the provision and documentation of Day Habilitation services, and improperly avoiding the return of overpayments received from the Medicaid program for Day Habilitation services that failed to meet requirements.
According to the settlement agreement approved by U.S. District Judge Valerie E. Caproni, Community Options has also agreed to pay $2,868,085.74 to the State of New York to resolve the State of New York’s claims, for a total recovery of $5,016,626.11.
In connection with the settlement agreement, Community Options has also entered into a Corporate Integrity Agreement with HHS-OIG, requiring them to maintain a compliance program designed to foster adherence to federal health care program requirements and thereby protect the programs, and that they engage an independent organization to review claims they submit to Medicaid to ensure they comply with applicable requirements.
‘Individuals and entities that participate in the federal healthcare system are required to obey the laws meant to preserve the integrity of program funds and the provision of appropriate services to patients,’ said HHS-OIG Special Agent in Charge Naomi Gruchacz. ‘The settlement in this case involves a provider that is responsible for a vulnerable population, for which it should be prioritizing quality services.’
Defendant: Community Options, INC. and Community Options New York, INC.
Criminal Charges: Medicaid Fraud
City and State: New York
Exact Date: January 1, 2017, and September 13, 2024
Sentence or Outcome: $5,016,626.11 settlement
Dollar Amounts: $2,148,540.37 to the U.S. and $2,868,085.74 to the State of New York
Key Facts
- State: New York
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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