Thursday, April 22, 2010

Ohio AG Files Medicaid Fraud Against Nursing Home

Cordray Files Suit Against Nursing Home Provider
4/7/2010

(COLUMBUS, Ohio) — Ohio Attorney General Richard Cordray today filed a lawsuit against a large Ohio-based nursing home provider doing business under the name Carington Health Systems. The lawsuit alleges the company overstated nursing home expenses in reports filed with the Ohio Department of Job and Family Services (ODJFS), resulting in overpayments of Medicaid reimbursements for 21 nursing facilities.

“By artificially inflating its expenses, this company caused the Ohio Medicaid Program to overpay for services,” said Attorney General Cordray. “It is critical that Medicaid dollars are spent as intended and that we hold accountable those providers who try to take advantage of the system.”

Nursing facility Medicaid providers are required to report their costs for supplying services to residents. ODJFS uses those cost reports to calculate a per diem rate for Medicaid reimbursement paid to a nursing facility for each day that each resident resides in the facility.

The lawsuit, filed under Ohio’s Medicaid statute, alleges that Carington’s Medicaid nursing facility services providers over-reported certain consulting service expenses in their 2003 cost reports. The result, according to the lawsuit, was an inflated per diem reimbursement rate for fiscal years 2005 – 2010.

The lawsuit, filed in the Franklin County Court of Common Pleas, seeks monetary recovery for the overpayment of Medicaid reimbursement and damages.

The nursing facilities named in the complaint are:

Arlington Nursing Home, Newark
Batavia Nursing & Convalescent Center, Batavia
Bryden Place, Columbus
Carington Park, Ashtabula
Clermont Nursing & Convalescent Center, Milford
East Galbraith Health Care Center, Cincinnati
East Galbraith Nursing Home, Cincinnati
Forest Hills Center, Columbus
Franklin Ridge, Inc., Franklin
Glencare Center, Cincinnati
Golden Years Nursing Home, Hamilton
Harmony Court, Cincinnati
Home at Hearthstone, Cincinnati
Heath Nursing & Convalescent Center, Heath
Madison Health Care, Madison
Nelson Park Care Center, Columbus
Sidney Care Center, Sidney
St. Catherine’s of Fostoria, Fostoria
St. Catherine’s of WCH, Washington Court House
Terrace View Gardens, Cincinnati
Woods Edge Point, Cincinnati

To read the full complaint, go to www.OhioAttorneyGeneral.gov/CaringtonHealthSystemsComplaint.

The Ohio Attorney General’s office investigates and prosecutes health care providers who defraud the state's Medicaid program and also enforces Ohio laws protecting mentally or physically disabled or elderly citizens from financial exploitation, neglect and abuse in long-term care facilities. Last year, the office’s Health Care Fraud Section recovered a record $91.4 million, breaking the previous year’s record of $65.2 million. Indictments increased from 164 in 2008 to 228 in 2009, and convictions rose from 187 to 215 last year.

Anyone who suspects patient abuse or neglect or Medicaid fraud can contact the Ohio Attorney General’s office at (800) 282-0515 or online at www.OhioAttorneyGeneral.gov.
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