Three nursing homes in the Buffalo, New York region will pay a combined $9 million to settle allegations that they submitted tens of thousands of fraudulent claims to Medicaid and Medicare over several years, New York Attorney General Letitia James announced in an official press release.
Three Buffalo-Area Nursing Homes Named in the Settlement
The facilities named in the settlement are Safire Rehabilitation of Northtowns, Safire Rehabilitation of Southtowns, and Williamsville Suburban Nursing Home, collectively referred to as the Safire homes. According to the announcement, the fraud took place from July 1, 2016 through December 31, 2020.
The investigation, conducted jointly by the Attorney General’s Medicaid Fraud Control Unit and the U.S. Attorney’s Office for the Western District of New York, found that the Safire homes submitted false data to the New York Department of Health that artificially inflated their Medicaid reimbursement rates. Under New York’s system, nursing homes submit data reflecting the care their residents need, and the state uses that data to calculate reimbursement rates for the following six months. Investigators found that the homes falsely overstated the amount of rehabilitative services certain residents required during periods that affected their reimbursement rates, then reduced those services during periods that did not affect rates — regardless of what residents actually needed.
Facilities Admit Wrongdoing and Will Pay $9 Million
Under the settlements reached with both the Attorney General’s office and the U.S. Attorney’s Office, the Safire homes admitted wrongdoing. Of the $9 million total, $6 million resolves the Medicaid fraud: $3.6 million goes to New York State and $2.4 million goes to the federal government. An additional $3 million will be paid to the federal government to resolve Medicare fraud allegations.
Beyond the financial penalties, the facilities are required to adopt new policies and procedures to ensure that Medicaid-covered residents receive all services they need and that those services are properly documented to prevent future fraud.
The investigation was triggered by a whistleblower complaint filed in December 2020 under the qui tam provisions of both the New York False Claims Act and the federal False Claims Act. Those laws allow private individuals to file complaints on behalf of the government and receive a share of any recovery.
How to Report Suspected Medicaid Fraud or Nursing Home Abuse
The Attorney General’s Medicaid Fraud Control Unit accepts confidential complaints about Medicaid provider fraud or nursing home abuse and neglect through its online portal or by calling (800) 771-7755. In emergencies, residents or families should call 911.
Residents and families with questions about Medicaid billing or nursing home care coverage should contact the New York Department of Health or their specific Medicaid plan directly to verify their individual circumstances.
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